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Date��a� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Z <br />Describe Proposed Work <br />ng <br />City <br />� <br />Zip <br />a�v ��N <br />Prolecl Address (il known) / `^ ✓ ' <br />Attach four (4) copies ot plans br proposed work - Draw lo scale and note Ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Pu�M1c Woiws Permil • <br />e�ae oeo�. • ���/�a.5-8<� <br />Puol¢ \vorks ice S <br />TO�aI Fee <br />Le�sAppi FeePa�d 5 <br />Datance Due S <br />• Centerline ol street <br />• Indir.ate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with Ihis permit and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Senice 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />��.�� t��/h- �1,�.�a` i'J�f <br />Conslruclion <br />.��9" <br />� ���� <br />3 -8 -�/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersi9ned owneUapPlicant hereby agrees to hold and save harm� <br />less the City ol Everetl Irom any ana all claims for damages, costs, <br />� expenses, or causes of action that may arise because ol installation <br />and maintenance ol Ihe improvement or other nc�ht�of-way use hereto <br />applied br and lurther agrees lo remove same upon notice irom Ihe <br />Date Cily and to replace public property damaged ihereby. <br />FINAL INSPECTION Dale <br />ApproveC as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl. WA 98201 <br />Phone: 259�8810 <br />Sic�nature ol AppliCan� "�" <br />WORK AUTHORIZED BY iH15 PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />