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� <br />�: <br />� <br />u <br />Date�1'. CO <br />a <br />� <br />o� <br />PU�IC <br />O <br />x <br />Print or Type Only � <br />� <br />Application For <br />WORKS PERMIT <br />O p <br />«i � <br />�� <br />Pu�iic Works Peimlt � �� �— �� � <br />Biaa oco�� • <br />Puol¢ woiFs Fcc <br />Total Fee S � <br />Less ApO�� Fee Pa�d $ n <br />ealanceDue S `���0 <br />Describe Proposed W.,rk <br />Prolec Addi255 0� known) <br />Altach lour (4) copies of plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • CeNedine ol sireel <br />• Outline and dimensions ol all existing and • Indrate North <br />proposed siructures on the Ict • Show any proposed gradin� changes <br />•[xisling and proposed utilities • Snow measurements <br />PEFId1T CONDITIONS <br />1. All callc for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2 All work shall be pedormed in acwrdance with lhis permit and current Cily ol cverett Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FRtE NUMBER 1•800-424-5555. <br />r � <br />, �rc�vr7:� �2 't'O _ <br />ApprovedlorConstruc� n � Date <br />/ � /_ <br />��l/L/ �d ' % ' �� <br />FINAL INSPECTION Da�e <br />Approved as Constructed <br />evercl� PUBLIC WORY,S DEPARTMENT <br />� 3200 Cedar Street <br />Evere�l. WA 98201 <br />Phone: 259-8610 <br />ACKNOWLEDGEMENT OF CONDI710N5 <br />W <br />H <br />� <br />N <br />� <br />N <br />O <br />a <br />The undersianed owner/applicar� hereby agrees to hold and save harm- <br />less �he City ol Everetl Irom any and all claims for damages, cosis, <br />expenses, or causes ol aclion Ihat may arise because ol inslallation <br />and maintenance ol the improvement or other rigM-of-way use hereto <br />applied for and lurther agrees to remove same upon notice Irom the <br />Ciry and to replace public propeNY damaged thereUy. <br />$igr/alGre ol Applicant uu�e <br />1NORK AUTHORIZED BY iHIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PENMIT IS ISSUEO AND THEREAFTER IS TO <br />AE DILIG[NTLY PURSUED TO CGMPLETION. THIS PERMIT MAY BE <br />CA�CELLFD �Y THE GITY UPON ANY STOPPAG[ OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />