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. . <br />Date % `�n �S <br />Application For <br />PUBLIC WORKS PERMIT <br />Print ar Type Only <br />.� <br />Pu�lic Workf Perml� + '-"� — � � <br />BIOp. OeD�� • <br />PuCIi� Worhs Fee <br />Totel Fee S <br />L¢SSAppI FeePa�C s n�n <br />BalanceDue S �� L�v <br />City <br />�Q t. .. L <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work �-� � � �� �' � •� � ^� <br />aN � �'� i[L' ,#�, n��'�= ��� ci�lt , <br />Project Address (il kno++n� <br />Attach lour (4) ccpies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centedine ol sVeet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All calls loi inspection shall be made 24 his. in advance - phone 2S9•881 5. <br />2. All work shall be per�ormed in accordance with this permit and current City of Everett Design and Consiruction <br />StandarAs and Specifications. <br />3. Call Locaticn Underground Service 48 hrs. �elore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�1/ /'a'—� ../i � "�� - �/ii S <br />Approved for Construction �� Date <br />��./l��l 7-,� �-�.c C <br />�FINAL INSPECTION Dat� <br />Approved as Consiructed <br />everelt �UBLIC WORKS DEPARTMENT ._� <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Fh.,ne: 259�8875 <br />ACKNOWLEDGEMENT OP CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims lor damages, costs, <br />expenses, or causes ol action ihal may a�ise because of installation <br />and maintenance ol Ihe improvemenl or other right•ol-way use hereto <br />applied for and lurther agrees to remove same upon notice Irom lhe <br />City antl to replace public property dama9ed thereby. <br />�1§natur ot Appiicant - ✓ va�e <br />WG1A AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEU BY THE CITY UPON ANY STOPPAGE OF WORK ON TFSIS <br />PROJECT OVER 90 DAYS DURATION. <br />