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Date�Ll�V I <br />App�ication For <br />PUBLIC `WORKS PERMIT <br />Print or TyGe Only <br />Mailing <br />Describe Proposed Work `—�� � I � `� <br />Proiect Address �if known� <br />�'/ L 4.t/ <br />20�. /O. :ri <br />b'% 10 C7. <br />PWhc Wo�ke Peemn • ^r�' �-�� <br />BI�9 Dapl. • l_]L��--� <br />PobhcWmksFee � <br />TOIPI FPP <br />Less Pppl. Feo Pnia S <br />Bnlance Due S '� C'L� <br />City Zip Phone <br />Attach lour (4) copies ol p�ans lor proposed work - Draw to scale and note Ihe lollowing as applicable: <br />� Property Lines <br />• Jutline and dimensions ef all existing and <br />propOsetl structures on the lot <br />• Exisling and proposed utilities <br />• Centerline ol street <br />• I�dicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDI710NS <br />1. All calls for inspection shall be made 24 Ivs. in advance- phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cali Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />1" ' ' / / Q � <br />�v�0%'L�'� �—,S c9 j <br />Approved for tructio Date <br />LGct;.� � + �i�-- �/��� <br />FINAL INSPECTION �� � Date <br />Approved as Constructed <br />everett PUBL�C WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF COND�TIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The untlersigned owner/aoplicant hereby agrees to hold and save harm� <br />less the City of Everetl Irom any and all claims for damages, costs. <br />ezpenses, or causes ol action Ihat may arise because of installation <br />and maintenance of the improvemen� or other righFol�way use hareto <br />applied lor and further agrees to remove same upon notice Irom ihe <br />Cify and to replace public property damaged thereby. <br />Sigr�flUre oVA pi�cam --- <br />WORK AU ORIZED BY THIS PERMIT MUST B� STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND 1HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO CCMPIETION. THIS PERMIT MAY BE <br />CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />