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Date�.SL!_� � / <br />� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�li i�il'l�.r� I�II� (� � <br />Owner Mailing Atldress <br />Describe Proposed Work <br />Prolect Address li( known) <br />�'ubhr Wo�Fs Pn /���"� <br />' oina o�o� . .�)_G.�LJ.LJ� <br />I Fuohcwar4eFce �� <br />Totnl Fec g — <br />LessFpPl fee Pn�d 5 <br />�alnnce Ouc 5 <br />City Lp Phone <br />� /'\��1%'('- �t2CL1 <br />Atlach four (4) copies ol plans lor proposed work - Draw to scale anA nole ihe following as apVlicable: <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposetl structures on the lot <br />• Existing and uroposed utilities <br />• Centerline oi street <br />• Indica�e Nor�h <br />• Show any proposed grading changes <br />• Show me.�surements <br />PERMIT CONOITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current Ci!y of Everett Design and Construction <br />Standards and Spe��lfications. <br />3. Call Location Unde�ground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />Approved for Construction <br />�� �g, <br />;�� <br />����.��� <br />�, ,� -�s�' <br />�CKNOWLEDGEMENT OF CON�ITI0��5 <br />W <br />H <br />� <br />� <br />0 <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />-- less the Gly ol Everetl Irom any and all claims lor damages, costs. <br />expenses, or causes ol action that may arise because ol installation <br />and maimenance of the improvement or oiher right-ol�way �se hereto <br />applied lor and Iwther a�rees lo remove same upon notice Irom ihe <br />D�te City and to replace pu6lic prooerly damaged thereby. <br />F INAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 CedarSlreel <br />Everett, WA 98201 <br />Phone:259�8010 <br />Signature ol Applicant Date <br />WORK AUTHORI2ED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 10 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />