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7 t, <br />aH <br />,oxx <br />[ H <br />a H fn <br />H�H <br />HC <br />H Cn CH" <br />Oy= <br />W n1:1 <br />H M O <br />rHy <br />H <br />ty v� <br />HOw <br />�C <br />Date <br />Appil,:atmn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />public Woks Perm <br />Bldg Dept <br />Pubis Works Fee <br />Total Fee <br />Less April. Fee Paid g <br />Balance Duo $ <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work 0fLk <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale <br />• Property Line: <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities: <br />note the following as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance -phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />_ 3. Call Location Underground Serviicee48 hrs, before you dig. TOLL FREE NUMBER 1-800-424.5555. <br />all <br />_ <br />Ieass'1 1 <br />Approved for Construction Date <br />W <br />FINAL INSPECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPART6IENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-BBIO <br />ACKNOWLEDGEMENT OF CONDITIONS <br />to — <br />CD <br />Im <br />Z <br />O <br />N <br />1.1.E <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. costs. <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE 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 />