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oata��7�$8 <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�. <br />PuEuc Works Permu a ✓�/ — ��/ <br />eia9 0�0�.. P,P � 7�— <br />Publlc Wa�ks Fee S <br />Tolal Fee <br />Less Appl. Fee PaiC S <br />BalanceDue g 2� <br />Applicant Mailing Address Cily Zip Phone <br />Describe Proposed Work <br />Prolect �ddress (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Properry Lines • Centerline of streel <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed siructures on Ihe lol • Show any proposed grading changes <br />• Existing and propo:zd ulilities • Show measuremeNs <br />PERMIT CONDITIONS <br />1. All calls for inspertion shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and SUecitications. <br />3. Call Location Underground Service A8 hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. <br />�, �� �" �1 �— p�„a� �2dU �u�unj �.30% <br />s ��z�r� -P'"��;:� �'.�4� -3 3. 7 �" 3oS <br />-�u,Q� �� �Cun.G�'� O �pP.,Es /��r�lcH.+ro> <br />v <br />� dIS.2F_GA.� Co,voi�o•�/s 5� �' s i� /,ovs� /S F�.�-{oP�o , <br />� _ /O /p �� <br />Approved for Cc strudi Date <br />8!�-�% <br />FINAL INSPECTI(�N Datr: <br />Approved as Constructed <br />evr�^tt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259�BB70 <br />ACKNOWLEDGFMENT OF CONDITIONS <br />W <br />H <br />�w <br />_/ <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of 6verett trom any and all claims for damages, costs, <br />expenses, or causes of action ihat may arise because of installalion <br />and maintenance ot the improvement or o�her ric�ht-ol-way use hereto <br />applied for and furlher agrees to remove same upon notice lrom ihe <br />City and to replace public property dam ged thereby. <br />G`1�4 <br />Signature ot Applicant � Dat� <br />WORK AUTHORIZED HIS ERMIT MUST 8E START D WITHIN <br />180 DAYS OF DATE ERMIT IS ISSUED AND THEREAFTER IS l�0 <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THG CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />