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Date�G <br />. �� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Describe Proposed Work <br />Project Address (if knowr) <br />PuDbc Worka Parm�� s <br />�_'\ <br />BiEB DeOt � !PG �Oi��G <br />Zip <br />Attach four (4) copies oi plans for proposed work - Draw to scale and note ihe lollowing es applicable: <br />• Proper�y �ines <br />• Outline and Aimensions ot all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />Pu�l¢ Works fee <br />To�sl ie! s <br />Less ApO� Fee PaiE S <br />Balence O�e S <br />• Centerline ol sireet <br />• �ndicate Norih <br />• Show any p�oposed grading changes <br />• Show measuremenis <br />Phone <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259-88i 5. <br />2. All work shall be pertormed in accordance with ihis permit and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. befo�e you dig. TOLL FREE NUMBER 1•800•424•5555. <br />f 11'.G'l �! <br />/I�0 L� �1�,�,�`s <br />���,�»�i .PF'c�� �,eFo ��/�i <br />��,�. <br />�/e' 6 <br />Approved lor Construction Date <br />FINAL INSPFt;`�,i,N Date <br />Approved as Construcled <br />eve:-« PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett WA 98201 <br />Ph o ne: 259-BB 15 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />i:•,,: undersigned owner/applicant hereby agrees to hold and save harm� <br />less ihe City ol Everett Irom any and all claims br damages, costs, <br />expenses, or causes of action Ihat may arise because ol installatioi, <br />and maintenance ol ihe improvement or olher right�oi-way use hereto <br />applied for and further a9rees to remove same upon notice Irom ihe <br />Ciry and �o replace public U�operty dama�jed Ihereby. <br />ol Applicznt <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUS7 BF STARTED WITHIN <br />190 DAYS C:F DATE PERMIT IS ISSUED AND Tr1EREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH�.", PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WOP.K ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />