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-,. <br />�: ,, <br />, .,:;. <br />° r ., <br />r _��:° ..,.�'? <br />,- <br />T ` <br />Dat?� ;h1 <br />Application For <br />PUBLIC �l4�ORK� PERMIT <br />Print or Type Oniy <br />87-3�Z <br />PUCIic Works Permit + ._ <br />Bltlg. D¢pl. a <br />PublicWo�ksFeo S <br />Tolal Fre <br />Leso FpO� Fee Paitl $ <br />� QO <br />e�i,�« o��� S = � �- <br /><�)'}ii� <br />—� Applicant Mailing Address City Zip Pho�e <br />Describe i'rnposed Work <br />Pmject Address (if known) ��'�� �"�Wc'C �C�G-�'�' � �� ' <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Properry Lines <br />• Outline and dimensions of ai� exis�ing and <br />proposed strvctures on me lol <br />• Existing and proposed utilities <br />Approved fo� <br />• Centerline ot streel <br />• Indicate North <br />• Show any proposed grading �.hanges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work !,hall be perlormed in accordance with this permit and current Ciry 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 />Oi <br />Date <br />.�� -�� <br />FINALINSF�ECTION Da <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everetl, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMC-NT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the CitY of Everett from any and all claims for damages, costs, <br />expenses, or causes of action thai may arise because of installation <br />and maintenance of lhe improvement or other right-ohway u5e hereto <br />applied for and further agrees to remove same upon notice irom the <br />Ltity and tu replace public property cj�maged thareby. <br />��/ 2 7 <br />Signature ot�nppiicani � ��•� <br />WORK AUTHORI_ED 6Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DA1�E PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETICN. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPACE OF WORK ON THI�� <br />PROJECT OVER 90 DAYS D:'RATION. <br />