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D�te�/'�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />_�� <br />owner <br />U- 0 � <br />Maihng ACdress <br />Appiicant Maih�g Address <br />DescriUr Proposed Work <br />.. <br />Project Address (if known� _ <br />PUEbc Works Pn�m�il • <br />BIEg. OeO�. � _ <br />P�pM1c Wo�ks Fee <br />TOIrIFee S <br />Less 4oui. fee Pa�o S <br />Baiance Due S <br />�� <br />Lp p <br />City Zip Phone <br />Attach four (4) cop�es of plans for proposed work - Draw to sr.aie ann ncle �he followmg a� apU�icable: <br />• Proper;y l.ines <br />• Outline nnd dimensions ol all existing and <br />proposso Slructure5 on the bt <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicale North <br />• Show any proposed gratling changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall bt: performed in accordance v+ith this permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Loca� n Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�����' ,� � <br />� �,: �8 ' � � �tl���, - <br />�f �r� ,�� f�,,� �d��- � . <br />� �-� �' 6� ,� <br />� N� <br />�r �' ; I �'� � � <br />�- <br />�,,�� �' �'�`..�; ��l � �.� <br />Approved tor Consiruction <br />FINAL INSPECTION <br />Approved as Construcled <br />��PUBLIC WORKS DEPFRTMENT <br />32C0 Cedar Sireet <br />Everelt, WA 98201 <br />Phone:259�8810 <br />Date <br />W <br />H <br />� <br />� <br />a <br />H <br />� <br />O <br />a <br />� ��'�� � ��� i.9 <br />ACKNOWLEDGEMEtJT OF CONDITIONS <br />The undersigned owner/applic2nt hereby agrees to hold and save arm• <br />� less ;he Gry o� Everett Irom any antl all ctaims for damages costs. <br />� expenses. or ca se� ot action Ihat may aris= bewuse of ins allation <br />� and mamtenance o! Ine improvemem nr olher righl-ohway u herelo <br />app��@C tOr and furiher agrees lo remova Same upon noiite (wm the <br />� City .v:tl to replaca public property darr�aged Ihereby. <br />d <br />Date <br />WORK AUTHORIZED BY THIS PEHM7 MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED .4ND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �E <br />CANCELLEU BY THE CITY UPON ANY STOPP.4GE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DUFiATION. <br />