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Date��(J <br />Applicat;on For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />mamny <br />Describe Proposed Work <br />Prolect Add�ess (if ki�own) <br />Zip <br />PUDhc Wo�ks Pcrmlt • / `-'? �� � <br />Biap DepL � _ J,13_� <br />Publ¢ WorNs Feo <br />total Fea S <br />Less Aopl Fee PaiU $ � <br />6alance Oun $ <br />4�025'�— <br />Phone <br />33y-�a,�s <br />[�p Phone <br />Attach feur (4) copies of plans lor proposed work - Draw to scale and ��te the following as applicable: <br />• Property Lines <br />• Outline and dirtiensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Cenlerlme of street <br />i Irdicate Nor�h <br />h Show any proposed grading changes <br />• Srow menauremenis <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 pedormed in accordance with ihis permit and current City of Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. hefore you dig. TOLL FHEE NUMBER 1-800•424•5555. <br />"7 / <br />�L <br />Approved as Constructed <br />everett PU6LIC WORKS DEPARTMENT <br />� 3200 Ceder Sireet <br />Everett, WA 96201 <br />Phone:259-8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O' <br />� <br />� <br />O <br />a <br />The undersic7ned ownedapplicant hereby agrees to hold and save harm- <br />le;s the Cily ol Everett Irom any and all claims tor damages, wsts. <br />r.xpenses, or causes of action that may arise 6ecause of installation <br />and maintenance ol the improvement or other right-ol-way use hereto <br />applied for and furlher agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature ol Applicanl " / Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITIiIN <br />180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThIIS <br />PROJECT OVER 90 DAYS DURATION. <br />