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Date� ��-��� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />Project Address (il known) <br />t'.�bi�c �va�s ra,m,t , <br />l <br />emq. oco�. • <br />Pu0licWorksFco $ <br />Totel Fea <br />Lasslppl FmPaid $ <br />Bnlnn<n Oua $ <br />?��V' 4��.� L k�C�I ��-1-C�`. <br />City Zip Phone <br />�" �(��ol� 'a,���� 3�`i <br />City Zip Phone <br />Attach lour (4) copies ot plans lor proposed work - Draw to sr,ale and note the following as applicable: <br />• Ptoperty Lines <br />• Outline and dimensions ot all exisling and <br />proposed stru:.tures on ihe lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />� Show messurements <br />t. All calls for inspection shall be made 24 hrs i� advance • phone 259•881 5. <br />2. All work shall be performed in accordance with lh�- permil and current Cily ot Everett Design and Construction <br />Standards and Specilications <br />3. Call Location Underground Service 48 hrs. befort ,uu dig. TOLL FREE NUMBER 1•800•424•5555. <br />�l/i3�.iC ����s r���,�� ,✓o r ,E'����.��.o <br />Approved for Construclion Dale <br />FINAL INSPECTION Datr <br />Appruved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />UEverett, WA 98201 <br />Phone:259•8815 <br />y 3-8� <br />c�� r� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />Z <br />O <br />H <br />� <br />� <br />a <br />The undersic�ned owner/applicant hereby agree� to hold and save harm• <br />less the City of Everett Irom any and all claims lor damages, costs, <br />expenses, or causes of aclion t' at may arise because ol insta�lation <br />and maintenance ol the improvement or oth��r right-of-way use hereto <br />applied lor and further agrees to remove same upon notice irom the <br />Ciry and to replace public property damaged thereby. <br />�ignature ol Applicant Date <br />WORK AUTHOqIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAl'S DURATION. <br />