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Date —. <br />Application For <br />PUBLIC �1141RICS PE�iMIT <br />Print or Type Only <br />Maifi�,� <br />Applicant <br />Describe Proposed Work <br />P�oject Address �il known) <br />City <br />Pu�Lc 4Vorks Pormit � _ <br />pi�9 Dcpi • — <br />PuLLS WOfkS iCC <br />,o�a� F�� s — <br />Less AOPI Fee Pauf $ — <br />Balanw Oue $ _ <br />Zip Phone <br />zX{'�%._ / ��>�✓ <br />ZiP � Phone <br />Attach four (4) copies o( plans lor proposed work - Draw Ic scale and note ihe following as applicable: <br />• Property Lmes <br />• Ou�line and dimencfon: of all existing and <br />propo5ed struclures on lhe lot <br />• Exis�ing and propOsed utilities <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposetl grading changes <br />• Show mcasurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance wilh this permil and current Ciry of Everetl Design and Construction <br />Standards and Spec'lications. <br />3. Cail Location Underground Service 413 hrs. before you dig. TOLL FREE NUMBER 1•iS00-424•5555. <br />�� �v�-/�.��.�`/l.r�%��� <br />,����'`�-i <br />y-�7- � o <br />Approved lor Construdion Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS CIEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259�8d10 <br />Date <br />ACKNOWLEDGEMENT OF CONCITIONS <br />� <br />� <br />♦�A <br />V♦ <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of Everetl from any and all cl3ims for dama9es, costs. <br />expenses, or causes of action ihat may arise because ol installation <br />and mainlenance of the improvement or olhrr nghPof�way use hereto <br />applied for and further ac]rees lo remove same upon no�ice irom the <br />City and to replace public property damaged the�eby. <br />Signature ol Applicant � Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITF:IN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THcREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />