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Dateil LL.i �� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,�f�i'(I i� i�i�' <br />4 Owner <br />Applicant <br />Describe ProUosed Work <br />Proje:t Address (if know�,i) <br />Mailing Address <br />I , . ii �, <br />Atlach fow (4� copies of plans for oroposed wurk - Dra� <br />• Property Lines <br />• Outline and dimens�ons ol all e.isting and <br />proposed structures on the lot <br />• Exis�ing and proposed u�ilities <br />l.ny <br />P ;:,„ <br />PuoliC Wmks Perm � '� <br />�- I <br />Bi�g_ Dept Y _ O ✓ <br />ruUl¢ Works Pee <br />Total Fee 5 _ <br />Less Aopl. Fre Pa�O $ _ <br />Balance Oue S _ <br />Z�p Phone <br />Zip Phone <br />scale and note the following a; applicable: <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed gradin9 changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phore 25J•$$10. <br />2. All work shall be peAormed in accordtmce with this permit and current Giry of Everett Des��n and Constr�etion <br />Standards and Soecitications. <br />3. Call Location Untleipround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />---��.�� �_ :�o�c �� ; �;_,�, � � �_ : _ <br />, ,� - ��, <br />,, i�� � � <br />�._��� �L� <br />� -�� -��o <br />� <br />Approved for Construction <br />I, FINAL INSPECTION <br />; Approved as Constructed <br />I everett PUBLIC WORKS UEPARTMEN7 <br />��, � 3200 Cedar Strz�t <br />� Everet�, WA 98201 <br />Phone:259�8810 <br />W <br />H <br />_ / <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Thr, undersigned ownedapplican! hereby agrees to hold and save harm- <br />le�s the City of Everett irom any and all cfaims for damages, costs. <br />r,xpen;es, or causes ot action that may arise because of installation <br />2nd maintenance of the improvement or other ric�hPol�way use here(o <br />appliaA for and furiher agrees to remove same upon notice irom the <br />Date City and to replace public property damaged Ihereby. <br />Date <br />SignaWre of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br />180 DAYS OF DATE PERMIT IS ISSUED AN� THEREpFTER IS TO <br />BE DILIGENTL'f PURSUE� TO COMPLET'ON. THIS PERM11IT MAY BE �'� <br />CANCELLED BY THE C! i'y UFON ANY STOPPAGE OF WORK ON THIS ' <br />PROJFST OVER 90 D;YS DURATION. ' <br />