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Date ,�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Apolicant <br />Mailing <br />Mailing Address <br />City Zip <br />PUEIic Woda Parmil •q �+ / ` � � <br />BIEB. DaPt • O ' ».J <br />7� <br />Puelic work: Fee S <br />Tolal Fae <br />Less ApO�- Fea PeiE S <br />Belance Oue S ��✓ <br />Phone <br />Describe ProFosed Work � ��j � � {� �1�(I�Q %G� N �S .L���"/'� �' A�� _ <br />' l <br />Project Address (if kcown) <br />5 <br />Attach four (4) copies of pians for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines � Centerline o1 s�reel <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities � • Show measuremenis <br />PERMIT CONDITIONS <br />1, All calls fo� inspection shall be made 2A hra in advance • phone 259-8815. <br />2, All work shall he pertormed in accordance wilh �his permit and current City of Everett Design and Construction <br />Standarils and Specifications. <br />3. Call Location Underground Service d8 hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />1..� <br />��� o �� <br />� � <br />�� �-- � ��� <br />� <br />��Z�v/c�3�L �/� � <br />Approved lor Con ruction 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 CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />■ <br />� <br />0 <br />a <br />The undersigned owner/applican� herehy agrees to hold and save harm• <br />less the Cily of EvereU from any and all claims for damages, cosis, <br />expenses, or causes ot aclion ihat may arise because of installation <br />and mainlenance of �he improvement or other right-ol-way use hereto <br />qpplied to�nd fur�er(3t]rr�es je�r�move same upon notice irom the <br />Cii�land iWr�nlate pu61k PraQ(rty d�maged thereby. <br />WORK AUTHORIZEd BY THIS F'E AIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS IS UEO AND THEREAFTEA IS TO <br />BE DILIGENTLY PURSUED TO COMP TION. THIS PERMIT MAY BF <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK OiJ THIS <br />PROJECT OVER 90 DAYS DURATION. <br />