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Date <br />, ...:.....: ... r-�, �-�� <br />� <br />, Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address �if known) <br />�. <br />Zip <br />Attach (our (4) copies of plans for proposed work • Dra�.v to scale and note the followinp gs applica6le: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existirg and proposed utilities <br />_w: <br />Public Woiks Permi� a _ <br />Bldp. Oept. s — <br />PuClit Works Fee <br />Total Fee $ - <br />Less A00� Fee Paid S <br />Balanco oue S <br />• Centerline of street <br />• Indicate Norih <br />• Show any prnposed grading changes <br />• Show measurements <br />.���=�1_ <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advanc2 - phone 259-881 5. <br />2. All work shall 6e performed in accordance with this permit and current Ciry of Everett DesiSn and Cons�ruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />��l �, �z��i1_l `f.' �'1C��f� I �"'�'� �%1 � �l"� <br />��,�G'' �o : � � <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF COiJDITIONS <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims 1or damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and mainlenance of tne improvement or other ri9ht-oFway use nereto <br />applied for and turther agrees to remove same upon notice from the <br />City and to replace public pro�erty damaged thereby. <br />'��� � � i14-�-�-'-v �'--�'='/i;��� <br />Signatureof�Applicant D te <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLEO BYTHE CITY UPON ANY STUPP.4GE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />