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Date � a:,ne. ,.�,�s a�,�:,i . <br />Application For <br />PUBLI� WORKS PERMIT <br />Print or Type Only <br />q3a= <br />Owner Mailing Address <br />Applican�, <br />Describe Proposed Work <br />Proiect Address (il known) _ <br />Mailinq Adtlress <br />City <br />9v,n oeq • _ <br />��ueim Wores Fee <br />Tolal Fne � _ <br />LessAoO� Fee Pa�J 5 _ <br />8aiance Doe $ <br />Phone <br />up Phone <br />Aaach four 1�) copies of plans lo� proposed work - Draw to stale acd nole the lollowing as applicable: <br />• Propeity Lines • Centerline of street <br />• Outline and dimenslons of all ezisting and • Indicale North <br />pwposed strudures on ihe �ot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <br />ir.�tiy <br />PERMIT CONDITIONS <br />1. All calls for inspection sl•.all br made 24 hrs. in advance • phone 259•8810. <br />2. All work shall b� peAormed �n acwrdance with �his pennit and c�rrent City of Everett Design and Conslruction <br />SiandarAs and Specilicaiions. <br />3. Cal! Location Underground Service 48 hrs. before you dig. TOLL F'REE NUMBER 1•800-424•5555. <br />�G��� l-�' ' f����.v0% �F���,.�� <br />� j°��u� Gy 1.��1if N��- � c��1L ���,,.�'.��� <br />Apprcved lor Consirudion <br />FINALINSPECTION <br />Approved as- Gons;ructetl <br />everMl PUOLICWORKS�EPARTMENT <br />� 3200 Cedar Street <br />Everelt. WA 98201 <br />Phonc:259�8810 <br />�/f�� /� gB <br />ACKNGW�EDGE�1ENi OF;,ONUITIONS <br />W <br />H <br />_ / <br />� <br />� <br />� <br />� <br />a <br />The undersir�ned owner/apPliCan� heieUy agrees to hold and save harm- <br />le;s ihe City ol Everelt trom any and all claims lor damages, costs. <br />e.penses, or causes ol action that may arise because, ol inslallation <br />and mainlenance ol the impwvement or other righboFway use hereto <br />applied for and further agrees to remove same upon notir,a Irom the <br />City and to repiace pubGc property damaged ihereby. <br />Signah��e of Applicant <br />Date <br />WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BF DILIGENTLY PURSUED TO C01.1PLETION. THIS PERM11IT ;t1AY BE <br />GANCELLED BY THE CITY UPON ANY STOPPAG[ OF CJORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION <br />