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Date_�Y <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Describe P�oposed Work <br />Project Address �if known) <br />cny <br />PuOhc Worhs Perm t • p <br />B�40 De�t. � � � ` ) � �� _ <br />PueLc Norxs Fea <br />Totel Feo s <br />Leas AO�� Fea Pele S <br />Balance0ue S <br />Atlach tour (4) copies of plans tor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of streel <br />• Outline and dimensions ol all existing antl • Ir,dicate Norih <br />proposed structures on Ihe lo� • F;how any proposed grading changes <br />• Existing and prcposed utilities • 51ow measuremenis <br />7�3- 39�s`r <br />Phon? <br />PERMIT CONDITIONS <br />7. All calls', r inspection shall be made 24 hrs. in advance - phone 259•831 5. <br />2. All work shall be performed in accordance with this permit antl current City ol Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00•424-5555. <br />Approved for Construction <br />FINAL INSHECTION <br />App�oved as Consirucled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. 1VA 98201 <br />Phanc:259-8615 <br />��Q�� I <br />� �� �� �: <br />��� , �� . <br />L <br />�� <br />< <br />W <br />H <br />�w <br />�/ <br />�• <br />� <br />N <br />0 <br />a <br />ACKNOWLEDGEh'FNT OF CONDITIONS <br />The undersigned cwner/applicant hereby agrees to hold and save harm� <br />less the City o( Everett Irom any and all claims for dama�es, cosis, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance ol the improvement or other righbohway use hereto <br />applied tor and lurther agrees to remove sama unon notice Irom the <br />Date City and to replace pu6lic property damaged thernby. <br />Date <br />Signature o! ApPlic�nt Date <br />WORK AUTHORIZED BY THIS PERAIIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CA\C[LLED BY THE GTV UPON ANY STOPPAGE Of WORK ON THIS <br />PROJ[CT OV[R 90 Di.VS DURdT10N. <br />