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Date�L�Q 0 � <br />AppliCation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />✓ <br />PubbcWorkaP t. `—' �!?� <br />BInO OeP1. � ���. <br />�r -� <br />P�pl¢WoewsFee S <br />Tolal Fee <br />less PpPI. Fne Pmd S�__ <br />Balance Duc $ �C� <br />L�-���.e �E��'�f 9�20� <br />�'�Y ZiP Phone <br />�• ) / ^ i� <br />Applicant Mailing Address City 2ip Phcne <br />Describe Proposed Work �� l�T �� ` 1� ��V.� (c-�� �1� <br />Project Address �il known� <br />Attach four (4) copies ol plans for proposed work • Draw to scale and note Ihe followiny as applicable: <br />• Property Lines <br />� Outline and dimensions of all existing antl <br />p�oposed structures on Ihe lot <br />• ExiSting and proposed utilities <br />• Centerline of 5treet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMITCONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All wark ahall be perlormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� ��I� � � �/ ,7 � _ <br />ApCroved lor C utruct'o Date <br />/-� o <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WURKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 99201 <br />Phane: 259�8810 <br />ACKNOWLEDGEMENT OF GONDITIONS <br />� � <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />7hc undersigned owner/applicant hcreby agrees to hold and save harm- <br />less the City ol Everelt trom any and all claims for tlamages. costs. <br />expenses. or causes of adion Ihat may arise because of installation <br />and maintenance ot the improvement or other right�ot�way use hereto <br />applied lor and further agrees to remove same upon nolice Irom the <br />Ci�y and to replece pubGc property damaged ihereby. <br />�-�-�� --�</-z�-�,� <br />Signature ol Applicant Da�e <br />WORK AUTfiOR12ED BY THIS PcRM1T MUST BE STAR7�ED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGEhTLY PURSUED TO COMPLETION. TNIS PERMIT A1AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPA(iE Or WORK ON THIS <br />PROJEC70VER 90 DAYS DURATION. <br />