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Date1 c� � � <br />.'n1 <br />qpplication For <br />PUBLlC WORKS PERMIT <br />Print or Type Only <br />Puehc wor6s Pr�mn � q <br />B�aa.oeo�. • � ` <br />Pu�l¢ Woiks �ee s -- <br />Tolel Fae <br />Lese PDOL Fee Paid S <br />9aiance Due <br />qpplicant Mailing Address <br />City Zip Phone <br />Describe Proposed Work <br />project Address (il known) <br />Attach four (41 copies ot plans br proposed work - Draw lo scale and note � Ce�I�e line ol �pQe1� able: <br />• Property Lines • Indicale North <br />• Outline and dimensions of all exisling and � Show any proposed grading changes <br />proposed structures on the lot � Show measuremenis <br />• Exisling and proposed u�ilities <br />PERMIT CONDITIONS <br />1. All calls tor inspection shell be made 24 hrs. in advance - Phone 259-8810. <br />2. All work shall be pertormed In accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underqround Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•B00'424-55 . <br />f� [ i � <br />, C(/�OZ� / -��,i<-C � D� /�Py� LL^ r!' <br />%�v6.�t � � <br />Approved lor Construc�ion <br />Date <br />Date <br />FINAL INSPECTION <br />ApProved as Constructed <br />�A��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evere��. WA 98201 <br />Phone:259�8810 <br />�� <br />7-�-9i <br />� <br />O <br />ACKNOWLEDGEMENT OF GONDITIONS <br />The undersigned owner/apPlicant hereby agrees to hold and save harm� <br />less the City ol Everetl Irom any and all claims for damages, cosls. <br />eapenses, or causes of aclion thal may arise because of instaUation <br />and maiNenance ol the improvement or o'�her righPol�way use hereto <br />applied lor and lurlher agrees to remove same upon notice Irom the <br />City and �o replace Public property damaged ihereby. <br />SignaWre ol ApPlicant <br />80RDAYSTOF DATED PEP"HTSISEISSUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSVcD TO COMPLETION. THIS FC-RMIT MAY BE <br />C�NCELLEU BY THE CiTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DPYS DURATION. <br />