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Date_y�cyZ <br />Appl(cation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuGlic Worka Parmll • <br />aiev� oeo�. + �6760 <br />PubGc Worke fee <br />Toiel Fee � _. <br />Less AoOi. Fee Paid S <br />Belence D�e S <br />_ annarA Will•- <br />Owner Mailing qddress City Zip Phone <br />Owner <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Wark FibOraldss Sw'+mm nQ pppl at SFR <br />Project. idress(ifknown) <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the following ae applicable: <br />• Property Lines • Centeriine of street <br />• Outline and dimensions of all existing and • Indicate No�ih <br />proposed structures on the lot • Show 3ny proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calL (ar ina�ection shell be made 24 hrs. in advance - phone 259-881 O. <br />2. All work shall be peAormed in accordence with thia permit and curtent City of Everett Desipn and ConatrucNon <br />Standarda and Specifications. <br />3. Call Lacetlan Underground Service 48 hrs. before you dtg. TOLL FREE NUMBER 1•800�4245555. <br />,., <br />� ,����, <br />_� <br />/�v,� ��2 �\/v✓ KS /� ✓'r✓! ; � /�U-� ,�e�.�,'rle,c! <br />��.��� <br />sz�-�� <br />�Ct� � �/'c3��1� j�19c.J'� �.2 C�n �' L�-e� � <br />� G�� $2t.�.1�—� � <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WqRK6 DEPARTMENT <br />3200 Cedar Street <br />EveretL WA 98201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from ary and all claims for damages, costs, <br />expenses, or causes of action that may arise because of instellation <br />and maintenance of the imprwement or o�her right-of•way use hereto <br />applied for and further agrees to remove same upon notice (rom the <br />City and to replace public property damaged thereby. <br />Signature o( Applicant Date <br />WORK AUTHORlZED BY TH!S PERMIT MUST 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 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />