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Date��"� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ci�y <br />Pu�4c WrnMs Permil • � `� <br />a��a o�o� . G <br />Pw,i�� wa�kn roe s <br />iotel Fce <br />Less PpO� fee Pe�C S—�— <br />Balnnce0ue S �� <br />Phone <br />App icant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (il known) _��n��Z_—�L/—��'"' �/---►�— — <br />Attec� lour (4) copies of plans for proposeA work - Draw lo scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions o1 all existing and <br />proposetl siructures on the lot <br />• Exisling and proposed utilities <br />• Centedine ol sireet <br />• Intliwte North <br />• Show any proposed grading changes <br />• Show measuremen�s <br />?ERMIT CONDITIONS <br />f. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. A�I work shalf be peAormed in accordance with this permit and current City ol Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />/ . U Lc�/✓Z-i� / S � �Gtif%E'L- /�/ .�/- /—l-r j tljF�L-- <br />FINAL INSPI <br />Approved as <br />evrrMt <br />e <br />S��c ��G����—�'�ir�S'.r T�' y! �� ' y <br />v?_ �/<L //J%/�it'�'T i �� �' S,� . � y . <br />ACHNOI'lLEOGEMENT OF CONDITIONS <br />onstructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WH 98201 <br />Phone: 259•BB70 <br />� <br />O <br />� <br />� <br />O <br />a <br />The unders�9netl owner/applicant hereby ac�rees to hold and save harm- <br />less lhe Ciry of Evere�t Irom any and all claims lor damages. costs, <br />expenses. or CauSes of aCliOn Ihat may arise hetause Of �n5�altation <br />and maintenance ol ihe improvemem or other n9ht�ol�way use hcreto <br />applied lor and lurther agrees lo remove p � notice Irom the <br />Gty and �o�Pubfic properry aged Ihereb� <br />�o< f-�E' � <br />Date _ <br />bF <br />WOfiAAUTHORIZ[D BY THIS PEi7M1T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEflEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANC[LLED BY THE CIiY UPON ANY STOPFAGE OF 17Gf7K ON THIS <br />PROJEGT O':'ER 90 DAVS DURATION. <br />