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� � -� <br />Datei:-1— ' <br />Application For <br />PUBL�C WORKS PERMlT <br />Print or Type Oniy <br />Mailing <br />P�I�bclYo�tiaPc� ' j �l�J <br />0109 Dept • ���1_ ''• t /•� <br />PuelicWorhSfee S <br />iolel fce <br />Less Ro01. Fea PaiE $ <br />Baiancu Dvo $ <br />-. J �� r� �.)�� <br />Zip <br />c� �` 7' �"'��� ' — <br />Phone <br />i . <br />- Applicant Malling Address City Zip Phone <br />Describe Propased Work <br />Prolec� Address (il known) <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note Ihe lollowing as applicable: <br />• Properry Lines • Centerline ol street <br />• Outline and dimensions ol all ezisting and • Indicate Norlh <br />proposed structures on ihe lot • Show any proposed 9rading changes <br />• Existin3 and proposed ulili�ies • Show measuremenls <br />PERAIIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with ihis permit and current City ol Everett Design and Cunstruclion <br />Slandards and Specifications. <br />3. Call Loca�ion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �•800•424•5555. <br />� /1. i ii <br />� ;` <br />Construction <br />� � r d <br />�� f,. ,� �' l/:.'. , r, <br />Dale <br />FINAI INSPECTION Dale <br />Approvr i as Construcled <br />cver 1t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />_ ,:j/i���i '�' . <br />, ,�, � <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKN0INLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City ol EvereU Irom any and all claims for damages, coets, <br />ezpenses, or causes of action that may arise because of instcllation <br />and maintenance ol ihe improvement or other righ�-oFway use hereto <br />applied lor and luriher agrees to remove same upon nolice irom the <br />Cily and to replace public properry damaged �here6y. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY 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 />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />