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Date �� / � <br />AFPlica�ion For <br />PUE�LIC WOFi1CS PERMIT <br />Print or Type Gnly <br />Owner <br />City Zip <br />PuD���c Wa�ks Permil r _' _ .__ % <br />BI4J OCJI. � _:�/'� . . . i.�1�Z�— . <br />Putil�c Wurks Fee <br />T�IqI Fae $ — <br />Le'.s �OP� Fee �aia $ — <br />Dalar<c Due � _ <br />Phone <br />Descri6e Proposed Wark �P Ni.,�" Tn+ il,1jy6A1 J4�1( u/- fi / l/i%N.('Na, ���"�" �,�(� � f��,4 � _ <br />�. U % ..� i,.", /_, <br />Project Address (if known) <br />Attach four (4) copies ot pla�s for proposed work - Draw to scale and note the tollowing as applicable: <br />s Properry Lines • Centerline of street <br />• Outline and dimensions ot all exi:,ting and • Indicate Norih <br />proposed structures <.,� ihe lot • Show any proposed grading changes <br />O Eristing and proposeo utilit�e5 • Show measurements <br />PERMIT CG'vDITIONS <br />1. All calls fcr inspection �� hall be made 24 hrs. in advance - phone 259•88� 5. <br />2. All u�ork shall he perlormeJ in accordance with ihis permit and current City cf Everett Desiqn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMOER 1•800•424•5555. <br />itJc� Dv. si.c �2�s <br />Approved loi <br />FINAL INSPECTION <br />ApGrcved as Gonstructed <br />ece��elt FUBLIC WORKS DEPARTIAENT <br />� 3200 Cedar Street <br />� EvereU, WA 98201 <br />Phone:259-�815 <br />.��i»iT �c'�nc-�i��� <br />/U-lo-d6 <br />�--�� <br />ACKNOWLEDGGM1�ENT OF CONDITIONS <br />The undersigned ownedapplicaN rc�euy agrees tc hold and save harm- <br />less the City of Everett Irom any and all claims Icr damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of �he improvement or other righl-ol-way use hereto <br />— applied for and Icriher agrees to remove same upon notice frum lhe <br />Dale City and lo replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED OY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />�;ANCELLED BY THE Cll"Y UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURHTION. <br />