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v,�..- _._ y -.� <br />Date�l�` � <br />qpplication For <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />c��v <br />c�ry <br />Describe Proposed Work <br />Prolec� Address (if known) <br />Attach four (4) copies of plans �or proposed work - D;aw to scale and note the IolloNing as applicable: <br />� Pruperty Lines <br />� Outline and dimensions of all existing and <br />proposed siructures on ihe lot <br />• Exisling an0 proposed utilitie^, <br />PubLc Works Permd r � �'n _ �O� <br />Blap Dopl.. <br />Pueiic Works Fee <br />Tolal Fee s �- <br />Less ApPI Fee Faie s�- <br />Belan[e Vuo S �0=� <br />353-� 77� <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for i�spection shall be made 24 hrs. in advance • phone 259•88� 5. <br />2. All work sha�l be performed in aCcordance with ihis permil and cwrent City ol Everett Design and Consiruction <br />Standards and Specilicalions. <br />3. Call Location Underground Service 48 h�s. belore you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />7. � <br />�s <br />G�IG� n/N��i D� Th'E <br />� <br />/� 1�iHm��.—F•e Co.vC'•e�TE� Cc�Lvc.�T .�?/�E <br />ro dE r.�s:.��e� i,v �.>-� �,,-c ,. �T �i,F <br />�� <br />7>,c'i�cw'si,/, <br />/ <br />�,�� .-l� ��- 5`�/`4.� <br />Approved for Constructron Date <br />������ G -�f �F% <br />FIN.1L NSPECTION a�e <br />Approved as Constructed <br />f e�eic:t PUBLIC WORKS DEPARIMENT <br />�� 3200 Cedar Sveet <br />Evere�L WA 98201 <br />F'hone: 259�BH� 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owneUapplicanl hereby agrees ro hold and save harm� <br />less the Ciry o� Everett irom any and all claims lor damages. costa <br />ezpenses. or causes ol action that may anse because of insta�lation <br />and maintenance ol the improvement or olher right•ol�way use hereto <br />apPlied lor and turiher ac�rees to remove same upon notice from the <br />City ar,d to replace Public property damaged thereby. <br />r � ,. � - <br />Si§nature o APPlicant �' Da�e <br />WORK AUTIiORIZED B THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEC! OVER 90 DAYS DURATION. <br />