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Date�,��(i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu�he Works Peun a O(9 ���J <br />BIQU. Oapl. s _ <br />PueGc works Fee <br />Total Fee S <br />Less Appl. Fee PaiO S -} <br />Balance0ue $ G��O <br />�iYl'1� <br />� Applicant Mailing Address City Zip Phone <br />Project Address (if kncem) <br />_ s, s,. <br />Attach four (4) copies of pians for proposed worA - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Qut�me and dimensions of all existing . nd • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities � • Show measurements <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs in advance - phone 259•881 5. <br />2. All work �hall be performed in a�cordance with this permit and current City of Everett Design and Construction <br />Standarcis and Specifications. <br />3. Call Location Underground Service 48 hrs. before yo� dig. TOLL FREE NUMBER 1-800•424•5555. <br />� <br />9�-.��'�.�� yi=�/�� <br />Approved for onstrucPion �. Date <br />�� � � ���f � � <br />—�/��...�-=�!:.� i-v 7- <br />FI(IAL WSPEC7tON Dale <br />Aporoved as Constracted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 91201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDiTIONS <br />W <br />� <br />� <br />Z' <br />O' <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees lo hold and save harm• <br />less the City of Everett irom any and all claims tor damages. costs, <br />expenses, or causes ol aciion [hat may arise because of installation <br />and maintenance ot the improvement or other righFof-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace Uublic property damaged ihereby. <br />'� �'�--- <br />: ) <br />Signa ure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUS7� BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WGRK ON THIS <br />PROJECT OVEF 90 DAYS DURATION. <br />