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Date�.P�� <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />, <br />Pu�Lc wo�As Pe�mtl • <br />Biep Deoi. . " <br />Pub�¢ WOrFS Pe! s <br />Total Fee <br />Less ArO�� Fee Pe�G S _ <br />BalanceDue s <br />��?c/ <br />2ip Phone <br />Zip Phone <br />Prolect Address (if known) <br />Atiach tour (4) copies of plans for proposed work • Draw lo scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensiorte ;�f a�l existing and <br />proposed structures on the lot <br />• Existing and proposed uti�ities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PEFMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs. in advance • phone 259•881 O. <br />2. Ail work shell be peAormed in accordance with this permit end current City of Everett Design and Construction <br />Standerds end Specifications. <br />3. Call Location UndPrground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-$00•424•5555. <br />�G�✓�w r�o� �.u�� /U� /�,��v,� <br />�� <br />S /7 �i� <br />Approved for Gonstruction Cate <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259-8810 <br />Date <br />ACKNOWLEDGEMENT OF GONDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />lhe undersigned o�vner/applicant hereby agrees to hold and save harm- <br />less the City of Everelt irom any and all claims fur damages, costs, <br />expenses, or causes ot action Ihat may arise because of installation <br />and maintenance of the improvement or other ngh�-oi�way use hereto <br />applied lor and lurlher agrees to remove same upon notice Irom ihe <br />City and Io replace pu6hc proPerty damaged thereby. <br />naWre ol Apphcant <br />Date <br />1VORK AUTfiORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFIER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV PE <br />CANCELLED BY THF CIT� UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />