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� <br />(" <br />� <br />Dal��% <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�'�/y <br />Mailing Addi <br />Mailing Address <br />City <br />Pu�lic Worke Permit • �/ <br />eldg. Dao�� • � J 3J4�. <br />a�ocowo�x,F„ s <br />Total Fee <br />�esa Appl Fea PaiC s <br />BalontnUue s <br />-�U <br />;9.�oJv <br />Phone <br />.--•-�/ ! 1J,. � P �%-ZL! <br />Describe Proposed Work � ' '��—rT'�—� �°'� ' t'�, � 'L Yt7�"� � <br />Projecl Address (if known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of sireel <br />• Outline and dimensions ot cll existing and • Indicate North <br />proposac structures on the lot • Show any proposed grading changes <br />• Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in adva�ce • phone 259-881 5. <br />2. All work sha�l be performed in accordance with this permit and current City of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />�9 <br />�� �f <br />W ` ;C � <br />Q b�'V �`,, �e ��. R 3 d`1 <br />� 'a I <br />� <br />Approved lor Conslruction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�! <br />W <br />H <br />w <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City oi everett irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ol the improvement or olher righPot-way use hereto <br />applied for antl turiher agrees to remove same upon notice Irom the <br />City and to repiace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLET�ON. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />7 <br />