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TYPE OR PRINT ONLY
<br />Describe Proposed Work
<br />Application For
<br />PUBLIC WORKS PERMIT
<br />PROJECT ADDRESS (if Icnown)
<br />PUBLIC WORKS DEPARTMENT
<br />3200 Cedar Sireet
<br />Everett, WA g8201 259-8810
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<br />Public Works Permit k ����
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<br />Pu61ic Works Fee $ '�Q On
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<br />Attach four (4) copies of plans for proposed work - Drew to scale and note ihe following if applicable: -.,-f 17:�::. �_ 0„(i�,�
<br />•Property Lines •Outline and dimensions of all existing and proposed sirucWres on ihe lo� •Exisiing and proposed otilities '.�. ra `-_ i�,
<br />•Centerline of sireet •Indicate Norih •Show any proposed grading changes •Show measurements �� ����� '�'� ,
<br />uu Nui wrtllE 6ELOW THIS LINE
<br />PERMIT �ONDITIONS:
<br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810.
<br />2. All work shall be performed in accordance with this permit and current City of Everett Design and
<br />Construction Standards and Specifications.
<br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBI'eR 1-800-424-5555.
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<br />FINAL INSPECTION Date 7� ��
<br />Approved as Constructed
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<br />ACKNOWLEDGEMENT OF CONDITIONS
<br />The undersi9ned ownedapplicant hereby agrees to hold and save harmless
<br />the Ciry of Everetl from any and all claims for damages, costs, expenses, or
<br />causes ot action that may aris? because of installation and mainlenance ot
<br />the improvement or other right-o(-way use hereto applied for and further agrees
<br />to remove same upon notice from the City and to replace public property
<br />dar�aged thereby.
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<br />Sgnature of App6cant ' � Date
<br />WORK AUTHORIZED �Y THIS I'ERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO
<br />CCMPLEfION. THIS PERMIT MAl' BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON ThIIS PROJEC70VER 90 DAYS DURATION.
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