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Date�� <br />Application For <br />PUBLIC W4RKS PERMIT <br />Print or Type Only <br />VuOia Wo�ha Permn � `� ��/ <br />Didp Dept � _���� <br />Put�bcWorksFee s <br />Total Fec <br />Less AaO� Fee Pai� s �� <br />Balanc • Oue S <br />Phor.e <br />dr Z J.r Z- �S// <br />Applicant MaiBng Address City Zip Phone <br />projecl Address (il knAy <br />Attach four (4) copies of pla br proposed work - Draw to scale and note the Ioilowing as appGcable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensio ol all ezisting and • Intlicate Nort� <br />proposed structures on e lot • Show any propos grading changes <br />• Existing and proposed utiliiM`s • Show measure ents <br />PERMITCONDITIONS \ <br />1. All calls 1or �nspection shall be made 24 hrs. in advance - phone <br />2. All work shail be pertormed in accordance wilh t\ permil and c <br />Staadards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. T LI <br />/�� -�C/''t' o�� <br />�. c...� sz�.�� <br />��--�,�,o� / <br />� �.�_ � <br />��� .�„� <br />lor <br />� <br />159-8810. <br />�ent City of Everelt Design and Consiruction <br />FREE NUMBER 1 •B00•424•5555. <br />/�e�•v3I� <br />�'.307 <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WOFiKS �EPARTMcNT <br />� 3200 Cedar Slreet <br />Everetl, WA 98201 <br />Phone�.259�8810 <br />ACI:NOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant heieby agrees lo hold and save harm- <br />less Ihe Cily ol Everelt Irom any and all claims lor damages, costs. <br />ezpenses, or causes ol action that may arise because of installa�ion <br />and maintenance of ihe improvement or other right�ol-way use hPrelo <br />applied lor and further agrees to remove same upon notice irom Ihe <br />City and lo replace public properry damaged thereby. <br />Signature ol Applicanl "�" <br />WORK AUTHGRIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS OURATION. <br />