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Date_Li tr>�� <br />Application For <br />PUBLIC WORKS PER61111T <br />Print or Type Only <br />Owner <br />Describe Proposed Work <br />Project Address (il known) <br />Mailing Address <br />City <br />Pu�hcY;o��spe�m�il J � <br />BIOp. Dept v ,_L�__L <br />PUGIic Works Fea <br />Total Fee S <br />Less FOo� Fee PaIC S <br />0alance Due 5 <br />Attach four (4) copies of plans lor proposed work - Draw lo scale and note the lollowing as applicable: <br />• Property Lines • Cen�erline ot sireet <br />• Ou�line and dimensions of all ezisting and • Indicate North <br />proposed:;trucWres on ihe lot • Show any proposed grading chsnges <br />• Existing and proposed utili�ies • Show measurements <br />PERMITCONDI��IGNS <br />Phone <br />i. All calls for ;nspectien shall be made 24 hrs. in advance - phone 259-$Si 5. <br />2. All work shall be performed in accordance with ihis permit and current City ot Everett 02sign and Cons�ruc�ion <br />Standards and Specificaticns. <br />3. Call Location Underground Service 48 hrs. before yo�� diy. TOLL FREE NUMBER 1•800•42a•5555. <br />Approved lor Consiruction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIG WORKS DFPARTMENT <br />� 3200 Cedar Sircet <br />Everett, l"+'A 98201 <br />Phone: 259�Bd15 <br />tiaT ������o ���8/ � <br />��� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z� <br />O' <br />� <br />The undersigned owneUappiicant hereby aqreec to hold and save harm- <br />less ihe City of Everetl irom any and all claims for damages, costs, <br />expenses. or causes of action �hat may arise because ol installalion <br />and maintenance of the improvement or o0ier right-of-way use nereto <br />applied tor and furiher a9rees to remove same upon notice Irom ihe <br />Date City and to replace public property c, maged thereby. <br />Date <br />Si9nalwe of Huplicanl DatR <br />WORK AUTHORIZED �Y THIS PERMIT I.�UST OE STARTED WITHIN <br />180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />6E DILIGENTLY PURSUED TO COMPLETICN. THIS PERMIT MAY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEF 90 DAYS DURATION. <br />