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Date ' ? ' � <br />• - Application For <br />PUBLIC WOfiKS PERMIT <br />Prinf or Type Only <br />�^��li ��, `�X'; l , i�.�' � . -�! �`� I 11 ��"l7Y � / � <br />Owner � Mailing Address <br />, Y(.171� <br />Applicant Mailing Address <br />Describe Proposed Work —.�- 7��� ���� ��i� 1"f�' <br />� <br />Prolect Address (if known) '��� � ��� � �� %� � ���( C���� ( <br />�; <br />Altach tour (4) copies of plans for proposed work - Draw to scale and note ihe following as applicable: <br />� <br />• Property Lines <br />• Outline and dimensions of al� existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Public Warks Permii a_ / � iy�V <br />BICq. DepL + <br />Public Work3 Pea <br />Total Fea S � <br />Less rlppl Fee Paitl S <br />Bolance Due S� <br />'C L <br />• Centerline of street <br />• Indicate North <br />• Show any proposeA grading changes <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259-SE � 5. <br />2. All work shall be pertormed in accordance with this pennit and current City of Everett Design and Construction <br />Standards end Specifications. <br />3. Call Lor,ation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />. <br />�� _l_- <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3?00 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259-8815 <br />`�-�f d� <br />Date <br />F.CKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <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 of Everett from any and all �laims tor damages, costs, <br />expensr.s, or causes of action that may arise because of instailation <br />and maintenance of the improvemenl or other rightrof�way use hereto <br />applied lor and luriher agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />,,)��;, ��, - ,: ��J-/(:-��� <br />Si�yynature of Applicent , Date <br />WORK AUTHORIZ�D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUASUED TO COMPLETION. TNIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURA710N. <br />