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Date���� l" <br />Application For <br />PUBLIC WORKS PERMIi <br />Print or Typa Only <br />Mailing Address <br />PubGc Works Pornut • <br />� � <br />eleg.Jepv+ � <br />City Zip <br />PUEIic Works Peo <br />Tolal Fee $ <br />Less AppL Fee Paitl g <br />Balanco Due S <br />Describe Proposed Work i�� � � cT�,���7 _ <br />Project Addreas (if knowr:) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the !ollowing as app�able: <br />• Property Lines ,• Centerline of street <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed structuras on the lof • Show any proposed grading changes <br />• Existing and proposed utilities -• Show measurements <br />PERMIT CONDITIONS <br />1. Alt calis for inspection shall be made 24 nrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />����- l'�C)L�I�1�� � <br />/ /O,�y <br />..- <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DcPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�� <br />� <br />�L� <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett trom any and all cleims for damages, wsts, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and turiher agrees to remove same upon notice trom the <br />City and to replace public property damaged thereby. <br />Signature ol ApPlicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITtIIN <br />180 DAYS OF DATE PEFMIT IS I�SUED ANL1 THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMriET�UN. THIS PERMIT IdAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. '�— <br />