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Date�� <br />�. <br />Applicaticn Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Desr.ribe Proposed Work <br />Project Address (il knownl <br />Pu00c Works Permp • � <br />Bmp. Uep�. r ��% / A-�Y[i✓ <br />Puhbc Warka Fee <br />Totel Fee 5 <br />Less AOoI. Fee Panl $ <br />Fiaiancc Oue �u <br />iip Phone <br />Atlach four (4� copies of plans lor proposed work - Draw ro scale and note the following as a�olicable�. <br />• Property Lines <br />• Oulline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centedine of street <br />• Indicate Norih <br />• Show any proposed grading chanc�es <br />• Shuw measuremenis <br />PERMIT CONDIYIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current Cily of Everett Desi�n and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 CedarSireet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />�L i��1,� �-�V�1 i � j�.CC �,' <br />�,,vLIM ��� <br />�2-- '+ - �� <br />A,^.KNOWLEGGEMENT OF GONDITIONS <br />W <br />� <br />N <br />�� <br />� <br />� <br />� J <br />'�A <br />V♦ <br />� <br />a <br />The unders�gned owneUapplicant hereby agrees to hold antl save harm� <br />less the City ol Everett from any and all claims lor damages. costs. <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance of the improvement or other right-of�way use hereto <br />Date applied tor and further agrees to remove same upon notice Irom the <br />Ciry and to replace pu6lic property darr�aged thereby. <br />Da�e <br />Signaturc ol .4pplicant Date <br />WORK F,UTHOFIZEL BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMiT I;� ISSUED AND THEfiEAI�TER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THI � PERIAIT MAV BC- <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />