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. . �_ .- T.�'1�WT�FY�r'C�-iT°iP4p� r' ' \ �.:i.Ti-t^c'TT�.�—�1'iAi'C _ _'OV"_ T. ' _ _ <br />.. . .. � . ' . �__ . . ._-� <br />, �, t,.��: . �-. � - — " -.r . . . <br />r�. <br />�8t@ � � ' � <br />Applicrtion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />7 <br />PuEI¢ Works Permil •C� ,,[ I � _ �Gr? <br />BIJ9. Deol. a /l l J/� � <br />I <br />Publ¢ Worb Fee <br />Total Pee s - <br />Less Appl Fee Pnld S_ _ <br />2C�� 00 <br />Baiance Due S _ <br />�1���/%�� � <br />Hpplicant Mailing Address City Zip Phone <br />Describe Proposed� Work � �al ( I �� ��! �(^ <br />U <br />Project Address (if known) <br />AttaCh four (4) copies of plans for proposed wurk - Draw to scale and <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />propo5ed structures on the Iot <br />• Ezistirg and proposed utilities <br />ihe follnwing as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed gratling changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•5810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•B00•424•5555. <br />'< <br />� /_ � <br />��%' E _�-__� -� :__ <��/�� <br />Approved for Cons�ruction �� Date <br />FINAL INSPECTION <br />Approved as Construcfed <br />everetl F'UBLIC WORKS DEPARTMENT <br />� 3200 Cedar SVeet <br />Everett, WA 98201 <br />Phone:250�8810 <br />Datr. <br />�CKNOWLEDGEMENT 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 Ihe Ci�y ol Evere�� irom any and all claims for damages. cosis, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the impiovement or other right�ol-way �se herelo <br />applied for ard further agrces to remove same upon notice trom the <br />Ciry and lp�replace publiF P��operty,dameged thereby. / <br />Signalure of Applicanl � ' • Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION <br />