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Date � '� C.� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ng <br />Mailing <br />Describe Proposed Work <br />Project Address (if known) <br />�-� <br />Public Works Permil • <br />�� _ <br />BIOg. Dep1. • <br />Puolic works Fee s <br />To�al Fee <br />laSs Appl. Fee PaiO S <br />Belance Due s <br />(%1�`}' �t'1������i�t/.,� '1ir7 ��.� <br />City Zip Phone <br />Cily Zip Phone <br />Attach four (4) copies ot plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. A�I calls for inspection shall be made 24 hrs. in advanc� • phone 259•881 5. <br />2. All work shall be pertornied in accordance with this permit and current City of Everett Design 2nd Construction <br />Standards and Specifications. <br />3. Call Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-SOO•424-5555. <br />�!/�L.il GtJC,��.rS /��,t"�?iT il/O%�'��L//.(:c/_� <br />lor Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />fJ'-v'1!: -��i � <br />�� <br />ACKNOWLEDGEMENT OF CONUITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The ur�dersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett Fror� any and a�l claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right�ol�way use hereto <br />applied for and (urther agrees to remove same upon notice Irom the <br />Date City and to replace public property damaged ihereby. <br />Date <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 D�LIGENTLY PURSUED TO COMPLFTION. ThiIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATiON. <br />