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Date_L�"�S� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailiny <br />Applicant <br />Address <br />'Lip <br />PunLr, wvks Pc�mO a �/� <br />BItlB Depl. + �_ l.. � <br />Pue�ic works Feo <br />Tnal Feo $ <br />Less AOC�. Poa Faitl S <br />Balancc Oue $ <br />Gescribe Proposed Work �� lIU� n� D �� n/�,�� <br />c -x r. <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale antl note �he foll�oviing as <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed ctructures on the lo' <br />• Existing and pr�posed utilities <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed qrading changes <br />• Show measurenenis <br />P'ione <br />Phone <br />PERMIT CONDITIONS <br />7. AII calls for inspection shall be made 24 h�s. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Stand�rds and Specifications. <br />3. C�II Location Underground Service 4A hrs. betore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />for Construction <br />��� �C�CS�j�(� <br />� � <br />Oate <br />FINAL INSPECTION �a�e <br />Approved as Conttructed <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />Everett, WA gg201 <br />Phoner259•8810 <br />/ ' / � <br />L. �2l <br />��2 � 9� <br />ACKMO'NLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />r� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less ihe City ef 'everelt from any and all claims for damages, coste, <br />expenses, or causes of action that may arise because of inslallation <br />and maiNenance of the improvement or other rir�hhof-way we hereto <br />applied for and furiher agrees to remove same upcn no!ice irom the <br />City and to replace public property damag^d ihereby. <br />Signa�ure of Applicant pT�P <br />WORK AUTHORI2ED BY TIiIS PERMIT MUST BE STARTED WI�fHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE'fION. THIS PERMIT MAY RE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAl'S DUAATION. <br />