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Date�c�U <br />Applica�ion For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />Applir,ant <br />Describe Proposed Work <br />Prolect Adtlress (if known) <br />Mailin5 <br />Mailing Atldress <br />Pm�m Ylwe, Pnrmn • � _—_ <br />�mu oeni , �'�-�.�(d.,5 — <br />Pu�Lc Wo�ks Fee § <br />Total Fee <br />Less Appl. Fee �aid 5 <br />Ba1an<e0ue $ <br />�IT ��i.�� r; S�f'—.�iJl r1 <br />Zip Phone <br />Zip Phone <br />Atlach four (4) copies of plans lor proposed work - Draw lo scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and diriensions. of all existing and <br />proposed strucWres on the lot <br />• Existing and prop05ed u�ilities <br />• Centerline of s�reet <br />• Indicate North <br />• Show any proposed gradinc� changes <br />� Show measurements <br />PERMIT CONDITIONS <br />t. All calls (or inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pertorned in accordance with this permit and currenl City of Everett Design and Construction <br />Slandards and Specifications. <br />3. Call Location Undergrcund Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424•S.ri55. <br />?� � <br />�.�(, "�l f l�n �'� = y"�=�� ��<<�f' <br />Appwvea lor Construction <br />FINAL INSPECTION <br />Approved as Gonsiructed <br />everclt PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Street <br />Everett. W� 98201 <br />Phone.259-�B10 <br />��� �//.�9 <br />�?` �Ce�c�� >«✓ <br />c. <br />�CKtiOWLtDGEMENT OF CONDITIONS <br />W <br />H <br />�/ <br />Z <br />� <br />/�q <br />V♦ <br />O <br />� <br />Thc undersiqned owner/applicant hereby ac�rees to hold antl save harm- <br />less the City ol Everelt irom any and all claims lor damages, costs. <br />exper.ses, or causes ol action Ihat may anse because of installalion <br />anc maintenance ol the improvement or other right-ol-way use hereto <br />applied lor and turther agrees to remove same upon notice irom the <br />Date Ciry and to ieplace public property damaged thereby. <br />Date <br />Slgnature of Applicant Date <br />WORK AUTHORIZ.D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE 'ERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH[ CITY JPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />