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�ate_�Gf�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ruoi�c woixs c � . 2 <br />�lao Oeo�. • �–+— <br />Pu01ic Worha Fxe s <br />T0�81 FGB <br />lesa AOo� fea Pnd $ <br />Beience Due a <br />Mailing <br />Describe Proposed Work <br />Proiect Address (it known) <br />up <br />A�tach four (4) copies ol plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Cen�erline ol street <br />• Outline and dimensions of all eaisting and • Indicate North <br />proposed siructures on the lot • Show any proposed grading chaiiges <br />• Exisling and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspeciion shall be made 24 hrs. in advance - phone 259•881 b. <br />2. All work shall be perlormed in accordance with Ihis permit and current Ciry ol Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•S00•424-5555. <br />/"UBG�!- L-UD,P,f�s' f �vs„iT /�T ,�'c�'G`�Ui��O_ <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Conshucted <br />evere[t PL'9LIC WORKS DEPARTMENT <br />� 320) Ced2r Street <br />Eveicn, VJA 9ffi01 <br />Phone 259�BB15 <br />� <br />(/S�G <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />N <br />� <br />O <br />♦i^ <br />V♦ <br />O <br />a <br />The undersigned owner/applicanl hereby agrees to hold and save harm- <br />less the City ol Everett Irom any and ail claims lor damages. cosls, <br />expenses, or causes of action that may arise because ol installation <br />and main�enance ol �he improvemenl or olher �ic�ht�ol-w�.y use hereto <br />applied tor and lurlher agrees to remove ��..ne upon notice irom the <br />City and to replace public property dam��ed thereby. <br />Signature of Applicant Dale <br />WORK AUTFIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUF.D AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUR4TION. <br />