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- : <br />Date ���i, <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Applicant <br />Describe Proposed tNork <br />City Zip <br />Project Address (il known) / � �-' � � �� � � � � -i �-- <br />Attach four (4) copies ol plans lor pioposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utili�ies <br />PERMIT CONDITIONS <br />Gu�Lc Works Permit • `�' �— /�` <br />eiag. Dept • ��� � ('�,�+ ��,� <br />PublitWorksFea s <br />Totel Fee <br />�ebs ApO� Fee PaiO s �f <br />Balance Doe S L �� <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 2W9•881 5. <br />2. All work shall be per(ormed in accordance with ihis permit and current City of Everetl Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />� ,T.us%ac� •�,�y�6«s ,.9r dorrvr� o�' 1�btd.vspoaTS <br />S, <br />Appwve tor <br />FINAL INSPF <br />Approved as <br />ew•rctt <br />�e <br />�i,s a�,.� n�,�U is <br />.9s A B��s•�Ess - <br />/.S-�7 <br />T�a ,��sti/���,��� � <br />l ��E'���� <br />T�S <br />�A�ct'!% <br />��,rs �.��,�,�� <br />/'7c.i� � .OG��%JI�:.jS <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone�.259�H875 <br />NoT To .a'E uS�O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />\ <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Thc untlersigned owner; applicant heieby ac�rees to hold and save harm� <br />less the Gty of Everett irom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of the improvement or other righl�obway use hereto <br />applied for and furiher agrees to emove same upon notice irom Ihe <br />City and replace p��c prop rt damaged thereby. <br />�z 8,� <br />Sic�nature of Applicant e�e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE Si ���RTED WITHIN <br />18C DAYS OF DATE PERMIT IS ISSUED AN� THGPFAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLE:D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT UVER 90 DAYS CURATION. <br />