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Jate��C <br />Appliwtion For <br />PUBLIC WORK� P�RMiT <br />Print or Type Only <br />rotai6ng <br />Describe Proposed Work _ � n/ I d J� /}-,� <br />Projed .�ddress (if known) <br />CiIY Zip <br />Puei¢ woins Permn . <br />Bldp. poPt ♦ .� L� y� <br />PUGLc Worka Fee <br />To�aIFOe S <br />LesaApP! FaePeid S <br />Bnbnca Oue <br />AttacP lour 14) copies ol plans for proposed work - Draw to sca�e and nole ihe lollowing as applicable: <br />• Property Lines 1• Centerline ol slreet <br />• OWline antl dimensions ol all existing and • Indicate North <br />proposed 5trucW res on ihe lot • Show any proposetl grading changes <br />• Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with ihis permit antl curren' City ot Everett Deeiqn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />!('�v /4/.Bl/C C-��U.F.fS' f F�'irii �Fy'�G�.C'�'O <br />APProveu '_ � .-,. .,. <br />Date <br />FI"IAL INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett bVA 98201 <br />Phonc: 259�6'15 <br />i <br />.> � <br />s�/2 ��6 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_/ <br />� <br />O <br />♦1"A� <br />V+ <br />� <br />� <br />The undersigneC owner/applicant hereby agrees lo hold and save ha�m� <br />less the City of Everett hom any and all claims lor damages, costs, <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance ol the improvemeN or other righFof�way use hereto <br />applied lor and luriher agrees to remove same upon notice Irom the <br />Ciry and to replace public property damaged thereby. <br />Signa�ure ol Applicant Date <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTFD WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOPK ()N THIS <br />PROJECT OVER 90 DAYS DURATION, <br />