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Date // � �J <br />1 <br />ppplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r <br />cnv <br />Pepbc Worhs Ppem�� • `' <br />Bieo Depl • ��% •��!�'�' <br />❑unuc WorxsFee s <br />Totaifee <br />leis Rpol iee PaiU <br />Belance Due S <br />� S/� !�� �-�%8S- <br />/�� � T/^, �yI <br />Desc�ibe Proposed Work LSI��,-�L-G— '^' �j' ��� <br />Projer.t Address (if known) <br />� <br />Attach lour (4) copiBs of plans for proposed work - Drew to scale and note ihe tollowing as applicable: <br />• Property Linas <br />• Out�ine and tlimensions o1 all existing and <br />proposed structures on Ihe lot <br />• Existing and proposed utilities <br />• Centerline of sheet <br />• Indicate Norih <br />• Show any pioposed grading cha�ges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspeotion shall be mada 24 hrs. in advance • phone 259•8870. <br />2. All work ahall ba perto�med m acwrdance with lhis permit and current City of Everett Design and Construction <br />StenAards and Specificationa. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL PREE NUMBER �•800�4245555. <br />P�� w� ,�,�,� .�,��,�.�,,,�-� <br />��'�� <br />/Z- J" �O <br />Approved tor Consiruction <br />FINAL INSPECTION Oate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: �59��810 <br />hCKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />�� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett irom any and all claims for damages, costs. <br />expenses. or causes of action Ihat may erise because ol iastallation <br />and maintenance of the improvemenl or other righFol-way use heiefo <br />applied lor and further agrees to renove same upon noUce Iwm the <br />Ciry and to replace public properiy damaged tliereby. <br />Signature oi ApPlicant Date <br />WORK AUTHCR12ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISS"EU AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />