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Date��� <br />Applicalion Foi <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />innwny <br />� <br />lilty <br />Describe Proposed Work ` f9 7- y �[?/�n�1hP�l Nlk�_ <br />7 <br />Proiect Address (il known) /�w — <br />3� _Z��_� <br />��� � Pu�lic WOrks Pormpit • �/ / ai 9 <br />BICg.Dopt• (1� ��% <br />Publl[ Work9 Feo $ <br />TotalFea <br />Less Apot Fee Paitl $ <br />�.QpU <br />BaiancaDue S <br />Attach four (4) copies ol plans lor proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Oulline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Cor.;trudion <br />Standards and Specifications. <br />3. Call Loc2lion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />%r�i - 7c��l�2 / � �% <br />Approved for Co � ctio Date <br />��iii �-� <br />fINAL INSPECTION Date <br />Approved as Construded <br />everett PUBLIC WORKS D[PARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98207 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />Thc undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City of Everetl from any and all claims lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maiMenanCe of the improvement or other right�of�way use hereto <br />applied for and further agrees to remove same upon nctice Irom the <br />City and to replace public property damaged thereby. <br />4 ' �/a 7�"� <br />Signature of Applicant �— Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST HE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TI�IS PERMIT MAY BE <br />CANCELLED BY TI1E CITY UPON ANY STOPPAGC OF WORK ON THIS <br />PqOJECT OVER 90 GAYS OURATION. <br />