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��Date� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu�bc WorA� Permit • �✓ � <br />eme oam • <br />Total Fee � <br />Less OOV�� Fee PeiJ S <br />Belancc Oue S <br />�1�b� �1 ati�c ����vSc S� 60— S' 1 s-�� hu�-�-�" �-`°`c� fcz�3 <br />c�iy <br />qpplicant Mailing Address City 2ip Phone <br />DeScribe PrOposPd Work �' ov� Vo-" j-� G'�'� ��� 1C ���— �"`�` <br />Project Address (il known) s ��/� <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed struclures on ihe lot <br />• Ezis�ing and proposed u�ilitie5 <br />• Cenlerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PEFMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be pedormed in accordance with �his permit and current City ol Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Unde�ground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�'� /�j�i�✓��i��J <br />� <br />FINAl INS^ECTION <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett WA 9d201 <br />Phone:259�8810 <br />��'f�-:=�c' ��T� � <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned ov.�ner/app�icanl hereby agrees 10 h�ld and 5ave harm� <br />/ less Ihe City ot Everett from any and all claims lo� damages. costs. <br />��expenses. or causes ol action that may arise because ol installalion <br />and maintenance ol Ihe Improvement or other righ4of�way use hereto <br />applied for and lurther a�rees to remove same upo,. notice Irom ihe <br />�a�e City and to replace public property damaged thereby. <br />/ ��f'....P (r� ,L��_.__� -s� <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT A�UST BE STARTED WIiHIN <br />190 DAVS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />6E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCE�LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />