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Date���� <br />�� <br />Application For <br />P�IBLIG �1/ORKS PERMIT <br />Prir�t or Type Only <br />Puchc WorFs Perm�n • I <br />BIOg. De01. + �,�j�_ , _ <br />Publ¢ Works Fee $ <br />Tatal Foe <br />Less POPI Feo Paia $ ___ <br />6alante Ure $ <br />z�� <br />Describe Proposed Work _f�,� • � <br />Projecf Address (if known) <br />Attach four (4) copies of plans tor proposed �vork - Drew to scala and �•���!�, the Icilowing as applicable: <br />• Property Lines • Centerlinc ol streel <br />• Outline and dimensions of all existing and • Indicafe North <br />proposerf structures on the lot • Show any proposed grading changas <br />• Existing and proposed utilities • Sh!ow measur2menis <br />PfRh�iT CONDITIONS <br />�. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. A!I work shall be peAorn�nd m accordance with ihis permit and current City of Everet; Design and Construction <br />Standards snd Speciticatiuos. <br />3. Ca;� tor.ation UndE�ground Service 48 hrs, before you dig. TOLL FREE NUMBER 1•$00•424•5555. <br />!�%�o..� ���r�-�n;� �o � ,���,.�p <br />�� ��� <br />� <br />/o-2z-90 <br />Approved lor Construction <br />ACKNOWLEDGEMENT Of CONDITIONS <br />� <br />� <br />� <br />a <br />The undersi9ned owner/applicant hereby agrees to hold and save harm� <br />less the Cily of Everett (rom any and all claims for damages, cosis, <br />^cpenses, or causes ot action that may arise because ot installation <br />and maintenance of the improvement or other right-of-way use herelo <br />applied lor and furlher agrees to remove same upon notice irom the <br />Date Cily and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259-8810 <br />Signature of Applicant Uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TU <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON P.NY STOPPAGE OF WORK ON TIiIS <br />PROJECT OVER 90 DAYS DURATION. <br />