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Date� TO POSTI <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />-ti-a �o/Z�o <br />blit WOfkS PC/mil s <br />eiae. o�o�. + 9 �,�� 3 % .�i <br />Pubbc Worhs .'ee <br />Totnl Fcc S <br />Less no��. Fce Paitl $ n � <br />Balan<e Due S ��C7c./^ <br />Cw o,. %�io�n� Ao (3ox `ll4�i f�iPlli�ilu� %eY/9 `-/59-3dS�e <br />Owner 1 Mailing Address City 2ip Phone <br />Mailing <br />Describe Proposed Work <br />Prolect Address (if known) <br />���Y <br />y <br />Zip <br />Attach four �4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions oi all ezisting and <br />proposed strucWres on the lot <br />• Existing and proposed ulililies <br />• Centerline of street <br />• Indicate Norih <br />• Show any propo5ed grading changes <br />• Show measuremenis <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 i� accordance with this permit and current City of Everett Design and Construction <br />Stenderds end Specifications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />�R�.�� Vl�`�-e� �i�25�9t> <br />Approved tor Construc ' n Date <br />�� ��' 6-��-�/ <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phonc:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everell Irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ol the improvemen[ or other right-ol-way use hereto <br />applied �or and further agrees to remove saine upon notice Irom the <br />City and to re,yface public property damac�ed ihereby. <br />C, <br />/, f� <br />WORK AUTHORIZ D Y S PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF D PE IT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />