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Datel 41k Y <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type On'y <br />rvt.. Cd <br />ailing Address City <br />Applicam Mailing Address City Zio <br />Describe Proposed Work <br />Project Address (if known) <br />Works Permit + Bldg <br />aloe oepl. + <br />PubLC Nbrks Fee S <br />Total Fee <br />Less Aeol. Fee Paid $ <br />B.lance Due $ 2000 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />Ba+-riii Cd., only be mo✓ed oaw.irer ei/'enfe. dnd <br />dPprowed by T •Ff;c enyfneer,-'j d��C.. IT-5 re;ntt-Ited.arf <br />lia-6*,1a1 +o be. reused.. :51,9 111z3/oval, <br />s R'e4011/4W S/17' FiNG,K Pam.? C17y Log .9e0A/&- <br />ujW S,Or OF L aT, <br />Approved for Constr n Date _ <br />FINAL INSPECTION Date <br />Approved as Constructed <br />I <br />rett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone. 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ca <br />0 <br />n <br />z <br />0 <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all 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-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />A-L <br />igna ure of pplicant 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 DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />