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TYPE OR PRINT ONLY <br />�� <br />Applicant <br />Appliwtion For <br />PUBLIC WORKS PERMIT <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />Attach four (4) copies o( plans for proposed wo�k - Draw to scale and note the following it applicable: <br />/ <br />Date �� 9 9 � <br />Public Works Pertnit p / �z 3 <br />Building Permit q <br />Public Works Fee $ _�� � <br />aa <br />'Property Lines •Outline and dimensions of all existing and proposed structures on ihe lot •Existing and proposed utilities <br />•Centedine of street •Intlicate North •Show any proposed grading changes •Show measurements <br />:.J.' ♦ l�:'�.4� . • . u. <br />PERMITCONDITIONS: ��,�_;�_, --� <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. ': ---� +,,_ ��� <br />2. All work shall be peAormed in accordance with this permit and current City of Eve(ett Design'arlp <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you �ig. TOLL FREE NUMBER 1-800-424-5555. <br />� �l�/t�ir 2i^e � ,I'/<<�� /j� m�� �1�� <br />�h���� f� y�f �`�,<<<�s .����� <br />f�` �� ,���i . <br />`/)l�- ,,�rn�— .��Y�9 N <br />ApProved f onstrudion D e 7 <br />�.� � � /� / /, /S-i �/� � <br />L/_ <br />FINAL INSPEC I N Dat <br />Approved as nsiructed <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harmless <br />ihe City ol Everett from any and all claims lor damages, costs, expenses, or <br />causes of aqion that may arise because ol installation and maintenance ot <br />the improvement or other right-of-way use hereto applied for and luriher aqrees <br />to remove same upon notice (rom the City and to replace public propeAy <br />damaged therehy. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLV PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WOHK ON THIS PROJECT OVER 90 DAYS DURATION. <br />