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Date <br />Applic2',ion For <br />PUBLBC V6/ORK� �'�R►VI1 i <br />Print or Type Only <br />Mailing <br />Propt�sed Work <br />Pro)ect Address (if known) <br />Address <br />Public Wons Permii r <br />BIEB. pepl. + _ <br />PubllcWorksFee S <br />Tolal Fee <br />Less RppL Fee Pa�O S <br />BEI811C8 I�JB S . <br />[ip �none <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the following as applicable: <br />• Properry Lines • Centerline of sheet <br />• Outline and dimensinn5 of all ezisting and • Indicate North <br />proposed structures on the lot � • Show any prop�sed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspecti �n shall be made 24 hrs. i�� advance - phone 259-5$1 5. <br />2. All work shall be pe rformed in accordance witn this permit and current City of Everett Design and Construction <br />Standards and Spr cifications <br />3. Call Location UnCerground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />n„f�i <br />/l�o /�,�.�'�� �.-`' , � <br />��� ��G�� <br />/���� <br />� <br />Approved for Construction Date <br />FINAL IGISPECTION Dete <br />Approvea as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 25!1-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damagas, costs, <br />expenses, or causes of acli�n ihat may srise becau,= ot installation <br />and maintenTnce of ihe improvemeN or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice trom the <br />City and to replace public property damaged thereby. <br />Signa�ure of AppliCant Date <br />WORK AUTHORIZEO BY THIS PERMIT MUST BE SThRTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUEO TO COMPLFT�ON. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ�CI' OVER 90 DAYS DURATIOta. <br />