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__ _ _'��.�e�_,��.+e.��.�..�R . � � f ��'�1��.�:. <br />,-��� � ��� <br />�8te�� J ' � 1 <br />Application For <br />PU�LIC WORKS PERMIT <br />Print or Type Only <br />owner <br />� � <br />Address <br />City <br />�� � � <br />WUec Wo�ka Per � <br />'' 3 <br />BIEp. Dapl. � � <br />PUEbc Worxa 1ee . <br />Totnl Fee s i <br />less �p01 Fee Pud s <br />Balance Due { �� <br />Appiicant Mailing Address City 2ip Phone <br />DescriDe Proposed Work <br />Project 4dAress (il known) <br />Attach lout (4) copies ol plans fo� proposed work • �raw�cale and note the following as applicable: <br />� Property Lines <br />• Outline and dimenaions of ell existing and <br />� prOposed structures on ihe lot <br />• Existing and proposed utilities <br />� �. <br />• Centerline of streel <br />� Indicate North <br />� Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All ulle for Inapectlon ehall ba made 24 hrs. in ativance • phone 259•881 O. <br />2. All work shall be peAormed in eccordence viith this permit end current City of Everett Design and Conatrudlon <br />StendeMs and Specifications. <br />3. Call Location Underpround Service 48 hra. before you dig. TOLL FREE NUMBER 1-800-4245SS5. <br />/ i-�/'"�-% <br />�"CRl tQ �� �"k.fSL I �" 4-_`�9 <br />Approved lor Construclion Date <br />FINAL IN�pECTION Data <br />Approved as Corstructed <br />everett PUBL.IC WORKS DEPARTMENT <br />� 3200 Ceder Streel <br />Everett WA 98201 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undersigned owner/applicant heieby agrees to hold and save harm- <br />less the City ol Eveiett Irom any and all claims lor damages, costs, <br />expenses, or causes ot action that may arise because of instellalion <br />0nd maintenance oi Ihe improvemenl or other right-ol-way use hereto <br />applied for and further agrees to remove same upon notice irom the <br />City and to �epiace public property damaged ihereby. <br />�/�i'�i0�.:�� ��'Ci0 � J / <br />nature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS ?O <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />