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Date��� �`=� <br />ApplicaPon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />Project 4ddress (if known) <br />Pu�hc AVarks Permil a l � � <br />C'e.— 'u <br />BIEp. DCO�� � —Z <br />Pu�l;c Work9 Fec <br />Totel Fee 5 <br />�uss AOPI. Foe Paid 5 <br />Balan<a Uuo $ <br />��'�� <br />Zip Phone <br />��''"��'-'y'% `�r�'-397a <br />7ip Phone <br />Attach four (4) copies of plans lor proposed work - n.aw to scale and note the following as applicable: <br />• Property Lines <br />• Out�ine and dimensions of all existin9 and <br />proposed structures on the lot <br />• ExiSUng and prOpoSed utili;ies <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading Changes <br />• Show measurements <br />PERPAIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phune 259•881 5. <br />2. All work shall be per(ormed in acwrdance with Ihis permit and current Cily of Everetl Design and Construction <br />Stanclards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i <br />��ii; `' /�' <br />Appruvad lor Cons�ruction <br />� � c�,��'�-s"' /�l �/±�� �'l�'�T ������G ;�,t'��_ <br />��� � � <br />, ��/% <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unAersigned owner/applicant here6yagrees to hold antl save harm� <br />less ihe City of Everetl from any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because ol installation <br />and maintenance of the improvemenl or other ric�ht-ohway use nereto <br />appGed lor and lurther agrees to remove same upon notice from the <br />���e City ind :o replac� public property d�ma9ed thereby. <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />evcrett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259-8815 <br />Signatwe of Appli-.ant Date <br />bVORh: AUTHORIZED OY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF W(1RI<ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />