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Date k/�/�� <br />� � <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proposed Work <br />Projr.ctAd,:resslifknown) ,,1I/ � �+— ��� I�PYC�- (i4JI !� <br />Attach four (4) copies o! plans for proposed work - Draw to scale and note the following as <br />• Property Lines <br />• Outline and dimensions of ail existing and <br />proposed structures on the lot <br />• Existir� and proposed u�ilities <br />� <br />PuSIICWarkpPBrmit+ ��__ <br />/� <br />61C0� Dapl. r {�/ 10 <br />PubllcWorkaFae $ <br />Totul Fco <br />Lese AppL FBB Pnitl � <br />Balunce Due <br />• Centerline nf street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•8&10. <br />2. All work shali be peAormed in accordance wilh lhis permit and currenl City ot Everelt Design and Construction <br />Standards and Speci(ications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/�L/ �/C`�f ' <br />� <br />Approved for Construction <br />���./� 8-d-8� <br />FINAL INSPF.CTION Date <br />Approvad as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />I w I 3200 Cedar Street <br />U Everett. WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_/ <br />� <br />0 <br />H <br />� <br />O <br />a <br />7ne undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everetl from any and all claims for dama9es, costs, <br />expenses, or causes of action that may arise because ot inslallation <br />and maintenance of Ihe improvement or other righhobway use hereto <br />applied for and turiher agrees �o remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant ua�e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTGR IS TO <br />BE DILIGENTLY PUNSUED TO COMPLETION. TH�S PEFMIT MAY BE <br />CANGELLED BY THE CI fY U?ON ANY STOPPAGE OF VJORi( ON THIS <br />PROJECT OVEii 90 DAYS OURH'i ION. <br />