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Date,���6 <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />r� <br />Pu�lit Works Permil ♦ <br />BIEg. Dept. s � �� <br />Public Worhs Fee <br />To!nl Fee S �— <br />Less A00� Fee PaiO 1— <br />Palence Due <br />Sa�v,,� <br />Applicant Mailing Address Cily Zip phone <br />Describe Proposed Work <br />Project Address (if known) <br />Attach four (4) cop�es oi plans for proUosed work - Draw to scale and note the following as applicable: <br />� • Property Lines <br />• Outline and dimensions of all exis�ing and <br />proposed structures on the lot <br />• Existing and proposed utilities � <br />PERM�T CONDITIONS <br />O Centerline of street <br />• Indicale Norih <br />• Show any pruposed grading changes <br />• Show measurements <br />1. All calls for inspection shall be made 24 lirs. in advance - phone 259•88i 5. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everelt Design and Construction <br />StTndarils and Specificafions. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-$00-424•5b5$. <br />/7�G�SS !�� �fiG/�.�O.ei/7/!r /�/2o�E.eTf/ <br />/s LJE�iE1> �,z Ty�' C� � o�' E�EreE'�' <br />�Ef�G ErTfJTE `Ummii?._<E <br />�O .pG.�L /G G/O.e.E'S <br />,Pc-~G.,o,cos Ta .�/E"w <br />ro -/i - B6 � <br />`� � <br />,,./ �BL <br />� <br />PE.PneiT .eER[.i.eEO u/�T// <br />Pc oi .�19N SoBi,�r..7Eo <br />Approved lor Consirur.tion Date <br />FINAL INSPECTION <br />Approved as Constructed <br />evcrMr PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl. WA 98207 <br />Phone: 259-68 7 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W■ <br />■ <br />� <br />� <br />� <br />The under;igned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everetl Irom any and all claims lor damages, wsts, <br />expenses, or causes of action that may arise because ol installation <br />and mainlenance ol the improvement or other riqht•of�way use hereto <br />a�ied for and i thet agrr,GQ t�remov9 same up�n notice Irom Ihe <br />andh pub�ic p�o' ert dama ed �hereb . <br />WORK AUTHOR12ED BY TFiI$ PERMIT MUST BE STARTEd WITHIN <br />180 DAYS OF DATE PERMIT�'IS ISSUED ANC THEREAFTEF IS TO <br />BE DILIGFNTLY PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />