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Date_ ���,�� <br />�'` <br />Application For <br />PUBLIG WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe i'roposed Work _. n �ta ) (��' �� (� k � <br />Project Address (if known) �� Q���3 �� r(:1 �� � <br />--- , --,.-----�--.--- <br />I �� <br />�` Pu011c Worka Permit k � l' <br />� <br />1 BItlg.Oept. x � / <br />Publi< Works Fee Q <br />Tolal Fea <br />Less Appl Fea Pald S <br />eaia��ao�e a �O�o <br />21p Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fol!owing as applicab�e: <br />. • Praperty Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIO�IS <br />• Centerlire of street <br />• Indicate North <br />• Show any propo:ed grading changes <br />• Show measurements <br />. 1. All ca�ls for inspection shall be made 24 hrs. in advance • phone 259-881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Constructlon <br />Standards and Snecifications. <br />.. -� 3. Call Location Undergrcund Service 48 hrs. before you dig. TOLL FREE NUMBcR 1•800•424•$555. <br />i <br />' �/ <br />Approved for Constructi n <br />ACKNOWLEDGEMENT Of CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owne�/applicant here6y agrees to hold and save harm- <br />less lhe City of Everett from any and all claims for damages, costs, <br />expenses, or causes oi action that may arise because of ins;allation <br />and maintenance uf the improvement or other right-of way use hereto <br />�`3-8� applied for anC further agrees to remove same upon notice from thr; <br />Date City and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIG WOAKS DEPARTMENT <br />� 320U Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />! e 7 / �' /�// <br />/ .�i'; �, // ' '�%Il.nirl �/ �'J <br />gnahue of Applicanl / Date <br />N�ORK AUTIfOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAY3 OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THI� PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />