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Date�jJ��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typ.. � �nly <br />Mailing Addr�ss <br />Describe Proposed Work <br />Project Adtlress lif known) <br />Attach four (4) copies of plens for proposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines <br />� Outline and dimensions of all ezisting and <br />proposetl structure6 on the lot <br />• Existmg and p.000sed utilities <br />PubLc 4Vaqa Po�m((11it •1� �/.�Q�j' ���" __. _. <br />91�9 OePI. � _WY- -��-{�---.. <br />Publ¢ Wmhs Fce '--�-"- _—' <br />TO�qIFPC '� - <br />Le55 Rppl F!e PTiO S <br />OV <br />�alrnce Duo s �_ <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />7. All celle for inspectlon ahell be mede 2a hrs, in advance - phone 259$810. <br />2. All work ahall be peAormed in accordance wlth this permit and current City of Everett Design end Construction <br />Standerda end Specilicationa <br />3. Call Location Undergrou�d Sarvice 48 hrs. belore you dig. TOLL FREE NUMBER 7•800�4245555. <br />�.���- � �/s� <br />Approved tor Construchon Date <br />�% <br />f -� �_1_G.-9u <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everetl PUBLIC WORKS �EPARTMENT <br />� 3200 Cedar Street <br />Everelt WA 98201 <br />Phone: 259-8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />r <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everetl from any and all claims for damagea costs. <br />expenses, or causes ol action that may arise because of installetion <br />and maintenance ol the improvement or other right-ol•way use hereto <br />applied lor and fu�ther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />L <br />Signature of Ap ic nt Date <br />WORK AUTH RIZED BY THIS PERMIT �".JST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANC[LLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />