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Date - �� ��� <br />Appiicati � For <br />P�IBLIC WORKS PERMIT <br />Print or Type Only <br />ess <br />� <br />CitY Zip <br />PubLc \Yo�ks Parm 1 +'% <br />BIdB. Deot. • � � � !S` � — <br />PuElic Wcrka Fee S <br />Total Fee <br />Less Appl Fee PaiA s <br />Balance Oue i <br />/rYt�/��Z <br />Applicant Mailing Address City Zip Phone <br />DescribeProposedWork ���-r�n��1 q-� iaL-��ci2�1-nr�rl <br />Prolect Address (if known) <br />AttaCh lour (4) copies of plens for proposed work - Drav <br />• Property Lines <br />• Outline and d�mensions of all existing and <br />proposed struCture� an the lot <br />• Existing and proposed utilities <br />to scale and note the lollowing as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading chenges <br />• Sh�w;ne:��uremenis <br />PERMIT CONDITIONS <br />1. All cails for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shell be performed in accordance with this permil and current City of Everett Design an� Construction <br />Standerds and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1-800•424•5555. <br />I JDIi'�L_/G Lc�O.CE-t f'>E�i'✓r�/T il/UT .Pc�CG'/.2C�0 <br />Approved for Con5lruction Date <br />FINAI. INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Slreet <br />Evere�t, WA 98201 <br />Phone: 259-8815 <br />�-/G �� <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicanl hereby agrees to hold and save harm- ' <br />less the City of Everett Irom any and all claims for damages, costs, �. <br />expenses, or cau,es of action that may arise because o1 instalfation i <br />and maiMenance oi ihe improvement or other righFof-way use hereto <br />applied lor and further agrees to remove same upcn notice from the <br />Ci�y and �o replace public propei;y damaged ihereby. <br />Signalure of Applican� Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE SiP.RTED WITHIN <br />780 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPIE�i ION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />