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� <br />Date�—i?�� �1 <br />Application For <br />PI.�BLIC WORKS PERMIT <br />Print or 1'ype Only <br />Mailing <br />Describe Proposed Work <br />% <br />r„i,i�r wn�k, reemn . <br />eiee o�o�� • —� Z��:f zr) <br />nu01 : wn,k: roo s <br />Tolel Fca <br />LeSSApt•� �eoPeid S <br />n,�a�coe�a S <br />z�n <br />City Zip ' Ynone <br />Project Address 1if known) � '�' ° � "^ / <br />Atlach tour �41 copies of plans br proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed slruCtures on the lot <br />• Ezisting and proposed utilities <br />• Centerline of streel <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shatl be peAormed in accorAance with this permil and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />��/BG�G' evo,ce�s /�.�,pin,� �l/aT �f'�G����,���� i /8-87 <br />`��� <br />Approved for Construdion ���e <br />FINAL INSPECTION Date <br />ppproved as ConsVuc�ed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreel <br />Everelt, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEUGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicaM hereby agrees �o hold and save harm• <br />less ihe City oi Everett Irom any and all claims for damages, costS <br />expenses. or causes of aclion Ihal may arise because o1 installation <br />and maintenance of the improvement or olher right�of-way use herelo <br />applied lor and furiher agrees lo remove same upon notice Irom ihe <br />Ciry and to replace public property damaged thereby. <br />SignaWre of ApPlicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEIJTLV PURSUED TO COMPIETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION. <br />