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Date�.�'�� <br />Application For <br />PUBLIC WORKS PERMlT <br />Print or Type Only <br />�,����,.�.v:o�.s��.���n��Q — <br />UI�itI DCP� � .�):1��� - <br />PWhc WorFs Fc <br />To„� Fo� s <br />Less ApPI. Fei• PaiO S <br />Balance �uc a <br />Phone <br />Annlicant Mailin�j Add�ess Giry up rnone <br />P:ojectAddress�ifknown) ��1d� �� 5�� �'�' <br />Altach lour (4� copies ol plans for proposed work - Draw to scale and note ihe following as appGcable: <br />• Property Lines • Centerline ol sireet <br />• Outline and dimensions ol all existln9 and • Indicale North <br />proposed siructures on Ihe lol • Show any p�oposed 9radinq changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall 6e purtormed in accordance wilh ihis permit and current City of Everetl Design and Construclion <br />Standards and Sper.ifications. <br />3. Call Localion Underground Service 48 hrs. before you dic�. TOLL FREE NUMBER 1-800•424-5555. <br />� q_�-s g <br />�� ��,��,,,;� �/oz� ,� . . <br />, <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />or Construction <br />Daie <br />FINAL INSPECTION Date <br />Approved as Consiruded <br />evereU PUBLIGWORKSDEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phnnc:259��810 <br />Z� <br />O� <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold a id =ave ha� nr <br />less the City of EvereU Irom any and all claims for tlan.: �es. cosls. <br />eapenses, or causes ol action that may arise because af mstallahon <br />and maintenance ol Ihe improvement or olher nghi�obway use horeto <br />applied lor and turther agrees to remove same upon notice from Ihe <br />City and Io replace public property damaged thereby. <br />Signature of Applicant ���� <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO C0�4PLFTION. THIS P[fih11T h1�Y B[ <br />CANCELLED BY THE CITY UPON ANY STOPP�GE OF 1NORK ON THIS <br />PROJ[CT OVEH 90 DAYS DURAiION. <br />