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Date��� <br />ApplicaliCn For <br />PUBLIC WORKS NE�MIT <br />Print or Type Only <br />Mailing <br />Describe Proposed Work ��JjlVe <br />Project Address (it known) <br />Address <br />Pu�LCWork�Permits `� �+w/��+"� <br />Bleq. Dzo�. • <br />PubbcWoikSFee y /7 —� <br />Tolal Fee S �[�S.'_ <br />Lesc Appt fee Pala � � <br />� <br />eaiancaUue 5 �_� _ <br />one <br />Q�� � rS7 <br />3�`i�3C� <br />Phone <br />Atlach tour (4) copies ol plans for proposed work - Draw to scale and note the following as applicable: <br />i Property Lines • Centerline of slreet <br />• Outline and dimensions of all existing and • Indicate North <br />proposed s�ructures on ihe lot • Show any proposed gradin� changes <br />• Exis�ing and proposed u�ililies • Show measuremert�s <br />PERMIT CONDITIONS <br />t. All calis for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in acwrdance with this permit ano current City ot Everetl Desi9n and Construction <br />Standards and Specifications. <br />3. Call Location UnGerground Service 48 hrs. beloie you dig. T�l, LL FREE NUMBER 1•80Q-424-5555. <br />,7/ YJ/r/Ui"✓Ji <br />Approved for Conslruction � � /D�(e <br />�-��'�i �/i�-�y <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everett PUBLIC WOPKS DEPARTMENT <br />� 3200 Cedar Street <br />Everell, WA 9820t <br />Phone:259�9910 <br />ACKNOWLEDGEMENT OF CONDITIGNS <br />W <br />� <br />_ / <br />z <br />0 <br />� <br />� <br />0 <br />a <br />The undersigned ownedapplican� hereby agrees to hold and save harm- <br />less Ihe City of Everett irom any and all claims for damages, cos�s. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or o�her nghbof-way use herelo <br />applied for and lurther agrees to remove sartie upon notice Irom the <br />City and to replace public property damaged ihereby. <br />- �-f� ��� <br />Signature of Appli ant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTF.D WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI�f MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIO�I. <br />