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Date�_L`7� 0 <br />qpplication For <br />PUBLIC WaRKS PERMIT <br />Print or Type Oniy <br />� J.. 3 �v <br />Mailin� Adtlress <br />Describe Proposed Work <br />City <br />z�n <br />Project Adtlress (il known) ._� i <br />Attach lour 14) copies ol plans for proposed work - Draw to ccale and note Ihe lollowing as applicable�. <br />• Property Lines <br />• Oulline and dimensions ol ali exlslin� and <br />proposed StruGlures On thn lot <br />• Ezisting and proposed utilities <br />R[L <br />Publ¢ Wo�l.s Pcr <br />BIaB Oept � � �-- - <br />PuUiicWo�ksFia g <br />Tolnl Fce <br />Le:S FPP�� Fee PaiO 5 <br />BaI0nre0ue $ <br />• Cenlerline ol Slreet <br />• Indicatc North <br />• Show any proposeA c�radiny changes <br />• Show measurements <br />�3y-aa <br />Phone <br />� J_�r _ '� c' <br />PEHMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in �dvance - phone 259•8810. <br />2. All work shall be pertormed in accordance with lhis permit and current Cily of EvereU Cesign and Conslruction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />YlG`� 1�cCjL�ll2`c� l�ao�BB <br />�9�� <br />Approved lor Construction Dale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone:259-8810 <br />ACKPJOWLEDGGMENT OF CONDITIONS <br />W <br />H <br />� <br />N <br />� <br />� <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant heieby ac�rees to hoid and save harm� <br />less tlie Gty ol Everett Irom any and all claims lor damages. cosls, <br />expenses, or causes ol action ihat may arise because ol installation <br />and maintenance of the improvement or other nght-of-way use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />Ciry and to replace public property damaged �hereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. TIi1S PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9C DAYS DURATION. <br />