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� Date�89 <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public WOrFs PelmO a <br />emo o�oi • — <br />Publ¢ Wor4s Fce <br />ioml Fee W <br />L?ss Anpl Fee Pnia $ <br />Balnnce Dun $ <br />,jSG � Goid <br />� /� <br />��� /-� %i+�i.w �/�n� a^i.St n� i. � i..__��.1J �/17_ � ��-. ��w�� <br />Describe Proposed Work <br />Project Address (if known) <br />iling Address <br />S� <br />� <br />City Zip Phone <br />Attach four (4) copies of plans for propo;,ed work - Draw to scale antl note Ihe lollowing as applicable: <br />� Property Lines <br />• Outline and dimension; of all existing and <br />proposetl structures cn the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />� Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - Ghone 259•881 O. <br />2. All work shall be pertormed in accordance with ihis permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Ca�l Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold ard save harm� <br />less ihe City ot Everett trom any and all claims lor damages, cosls, <br />expenses, or causes of ac�ion that may arise because ot installation <br />and maintenance of the improvement or other right-ohway use herero <br />- applied lor and further agrees to remove same upon notice Irom the �. <br />Approved for Construction Date City and ro replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBL�C WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 99201 <br />Phone:259-8810 <br />Signature ol 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 DILIGENTLY PURSUED TO COAhPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. , <br />