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Date��9 <br />App!iCat�on For <br />F'UBLIC WORKS F'ERMIT <br />F'rint or Type Only <br />Mailing <br />Describe Proposed Work <br />cuy <br />.-. <br />Zip <br />Pun��c wortis Peimu . <br />p140 �ePl � �44�.�3.ao�� <br />Pueirc Worhe Fee s <br />Totnl Fee <br />Less ApP�� Fce PaiA s <br />Oalance0ue i <br />Project Adtlress (il known) ����--.�� � d �-----^ —� N�—�n�n �'A�"'�- <br />Attach tour 14) copies of plans lor proposed work � Draw lo scale and note the follnwing as applicable: <br />• Properry Lines � Centerline ol street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on the Io1 • Show any proposed g�ading changes <br />• Existing and proposed utilities • Show mr.asurements <br />PERMIT CONDITIONS <br />1. All calls lo� inspection shall be made 24 hrs. ir a�vance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/l/0"7 ,4f� <br />� <br />Approved tor ConsVuction <br />FINAL INSPECTION <br />Approved as Gonstructed <br />everelt PUBLIC R'ORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone�.259�8810 <br />���-�� <br />�_2 �- � � <br />ACKNOWLEDGE�IENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />V) <br />O <br />a <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the Ciry ol Everetl irom any and all claims for damages, costs. <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance of ihe improvement or other right-ol�way use hereto <br />applied for and lurther agrees to remove same upon notice Irom the <br />Dale Ciry and to replace public property damaged thereby. <br />Date <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIi MAV BF <br />C�NCELI.ED BY TH[ CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DA�'S DURATION. <br />