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Date� O <br />�""; <br />Application For <br />PUBLIC WARKS PERMIT <br />Print or Type Only <br />Maifir.g Address <br />Mailing Address <br />Describe Proposed Work I\�,Ny�_( ^�)�!S_�� <br />Project Address (if known) <br />City <br />� <br />At!ach �our (4) copies of plans lor proposed work - Draw to scale and note �he following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />. proposed structures on the lot <br />• Existing and proposed utilities <br />PuoLCWoiksPermit. �� <br />Bldg. Depl. + � <br />lic Works Fee <br />TO�TI F^B `� <br />Less Ap01. Fee Paid 5��_ <br />BalancaDue $ �Q � <br />• Centerline of street <br />• Indicale North <br />• Show any proposed gradinc� changes <br />• Show measuremen�s <br />LINE <br />Phone <br />Phone <br />PERMITCOIJDITIONS <br />1. AI! calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in acwrdance with this permit and current Ciry of Everett Oesign and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424-5555. <br />-� 3 �� <br />Approved lor Constr . tyo _ Date <br />i � /� <br />✓/i`�� � "' O^ �•Oc� <br />FINAL INSPE TION Date <br />Approaed as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />[verett. WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everett Irom any and all claims for damages, costs, <br />expenses, or causea of action thal may arise because of installation <br />and maintenance of lhe improvement or other ric�ht-ol-way use hereto <br />applied for and furlher agrees to remove same upon notice irom �he <br />City and to replece public property damaged thereby. <br />r������{���%%f�k�—_----r����� <br />Si aWre ol App icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST B STARTED WITHIIJ <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />EE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />