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Dat� U—I21� <br />Application For <br />PUBLlC WOF%KS �ERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />Address <br />Viailing Address <br />c�iy <br />Qty <br />Lip <br />z�F, <br />Atlach rour (4� sopies o( plans br proposed work - Draw �o scale and note the following as applicable: <br />• Properry Lines <br />a Outline and dimensions ol all existing and <br />proposetl strucWres on the lot <br />• Existing an� pro�osPd utilities <br />��"�,��,. �•��,�. � Q_ <br />-/f - --- — <br />�im��. ocnc . /_ i _ — __. _ <br />! <br />Vublic Wo�ks Fcc S <br />Tolal Fec <br />less HPPI Fce PaiO S <br />Galanr.c Ouc S <br />C Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Sfiow nieasurements <br />one <br />Phone <br />PERMIT CONDITIONS <br />i. All calls tor inspection shall 6e made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be per(ormed in accoMance with this permit and current City of Everett Design and ConsVcction <br />Standards and SUecifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />V'1 i� � <br />ApProved fcr Construction <br />��C�UIr'�f� <br />` v9��� o� <br />� � ��. d <br />�1CKNObVLGDGEMENT OF COfJDITIONS <br />;; <br />;� <br />. <br />l he under;igned owner/applicant hereby agrees to hold and save harm� <br />Iess ihe Cily of [veietl from any and all claims lor damac�es, cosis. <br />ezpenses, or causes of action ih�t may arise because of installalion <br />and main�enance nf the improvement or other right�obway use hereto <br />- applied lor and lurlher agrees to remove same upon notice Irom the <br />�O�Q Ciry and to replace public property damaged ihereby. <br />FINAL INSPECTION Date <br />Approved as Construc�ed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 320G Cedar Street <br />Everetl, WA 98201 <br />?hone.25�J-9610 <br />Sic7nature ol Applir,anl Date <br />WORK AUTf10RIi.C-D BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF D4TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIUGENILY PUFSUED TO GOMPLFTION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF JJORK ON THIS <br />PROJECT OVER 90 GAYS DURATION. <br />