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Date�v o <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />�, : : �-., <br />Ciry <br />Ciiy Zip <br />8y-3s� <br />Pubbc worYs Perme � � a � <br />B�ee Deo�. • <br />Pu1�bc WorAs Fce S <br />Totel Fee <br />less aooi F¢e �e�a S a �b <br />Balance D�e S — <br />Phone <br />Describe Proposed Work ' I�-P� � `7� — <br />Projecl Address (i1 knowN '�302 � <br />Atl�ch lour 141 copies o1 plans lor proposed work - Draw lo scale and note Ihe lollowiog as applicable: <br />• Property Lines • Centerline ol slreet <br />• Outline and dimensions ol all cristing antl • Indicate No�tii <br />proposed structwes on ihe lot • Show any proposed grading changes <br />• Eaisling and proposed utililies • Show measurements <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance - phone 259-8870. <br />2. All work Shall6e pedormed in accordance with �his permit and current City of Everelt Design and Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER �-800•424•b555. <br />FINAL INSPECTION <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt WA 98201 <br />Phone:2F9-8810 <br />� , �. - /y <br />Date <br />/ia- So <br />ua�e <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned owneUapplicanl hereby agrees to hold and save harm- <br />less the City ol Everett irom any and all ciaims lor damages. costs. <br />expenses, or causes ol action that may anse beca��-e ol installaGo� <br />and maintenance of the improvement or other righ4obway use hereto <br />applied �or and luriher ag�ees to remove same upon notice Irom thr. <br />CitY 1nd to replace pubGc property damaged lhereby. <br />ol Applicant <br />�-l`1-89 <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERNIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEWTLY PURSUEU l0 COMPLETION. THIS PERMIT MAY BE <br />Ci1NCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 30 DAVS DURATION. <br />