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Date�� <br />Application For <br />�UBLIC WOF�KS PERMIT <br />Print or Type Only <br />City Zip <br />Cescribe Proposed Work <br />Project hddress (if known) <br />Pu[�ic Works �ermit x � � `-� � <br />BIrIB. Dap�. s ^ � _ <br />Gvblic N orhs Fee <br />7a1a Feo 5 <br />LessApP� �:e P['iJ $ �— <br />E1a:ance Due $ �� � _ <br />Atlach lour (4) copies of plans tor proposed work - Draw to scale and note the �ollowing as applicable: <br />• P�aperty Lines • Centerline of streel <br />• Outline and diniensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed gradinSl changes <br />• Existing and proUosed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. A{I calls (or inspection shall be made 24 hra in advance - phone 259-881 5. <br />2. All work shall be performed in acwrdance with this permit and current City of Everett Desic�n and Construction <br />Standards and Specifications. <br />3. Call Location Underc�round Service 48 hrs. br,fore you dig. TOLL FRtE NUMBER 1-80Q•424•5555. <br />r� <br />�\��� <br />�� �0�62z— .� .� 87 <br />Approved for Constru lio� Date <br />/C<r�l� �—/�—�� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceda, Street <br />Everett, WA 98201 <br />Phone: 28SiYl6 .�. Jr �'� �L i� <br />ACKNOWLEDGEMENT OF C;ONDITIONS <br />� <br />� <br />� <br />� <br />� <br />�w <br />_/ <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everetl from any and all claims For damages, costs, <br />expenses, or causes of ection lhat may arise because ol installation <br />and maintenance of the improvemenl or other right-of-way use hereto <br />applied for and lurthcr a{7rees to remove 5ame upon natice from the <br />Cily and to replace public property damaged therr.by. <br />(//��'�S ��y�'���_ /� /0--�-� <br />Signature ol Applicant Date <br />WORK AUTHOFiIZED BY THIS PERh11T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TfiEREAFTER IS TO <br />BE DILIGENTLY �=URSUED TO COMPLETiJN. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />