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Date�r/U <br />� <br />� - - -_...��- - _--- -----T- - - - - <br />Appiication For <br />PUBLIC WORKS �ERMIT <br />Print or Type Oniy <br />Owner <br />� <br />Mailing <br />Mailing Address <br />Describe Proposed Work �C��L. � <br />Projed Address (if known) <br />City <br />- �" �. <br />Zip <br />Publ�c WaMs Permu ♦ <br />eiae. oea�.. �i�j /.�[--. � S' <br />Pub6c Wodg Pee <br />Total Fea � <br />Less Anpi. Fee Pai� $ <br />Baianco ouo 5 <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note ihe lollowing as applicable: <br />L Property Lines • Centerline ot sireet <br />• Outline and dimensions ol all existing and • Indicate North <br />p•oposed strdctures onthelof • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />7 <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for ins{�ection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City cf Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE �!UMBER 1-800•424-5555. <br />/ G%�%�� �.. : /�% � � � � �� � �� <br />�-�c /� -�:�� - i,�. . .-/. .,r- 1�,��. ..�; <br />Approved for Construclion Da�e <br />F�NAL INSPECTION Date <br />Approved as Constructed <br />everet[ PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />.�;�',�6 -% - <br />� �i;' -i�/' <br />AGKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby ac�rees to holC and save harm- <br />less the City of Everett from any and all claims for damaqes, cosls. <br />ezpenses, or causes of action t:�at may arise because of installation <br />and maintenance of Ihe improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon nolir.e irom the <br />City and �o replace pu6lic property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHOFIZED BY THIS PERMIT A1UST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMP�ETION. THIS PERI.!IT h1AY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />