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rr <br />r <br />�� <br />L <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1 <br />r„i�i�o ..o,ws ao����i , <br />aw�,. o�ui . . 3 /' .y2.2 <br />Pu�HcWorksFae 5 <br />Ta�alFoo <br />Lrss Apn�. Foo PaiE $ <br />�� � � <br />�aiancu �ue $ <br />�2� �„ � n!I 1_ _,_ � l i � �^� �' 1 <br />Describe ProPosed Work <br />Prolect Address (i� known) <br />Attach lour (4) couies of plans for proposed work Draw lo scale and note Ihe following as applicable: <br />• Property Lines • CenterLne of sireet <br />• Oulline and tlimensions ol all existiny and • Indicate North <br />pro, osed structures on the lot • Show any proposed gradiny changes <br />• cxisting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance - nhone 259•881 5. <br />2. All work shall be performed in accordance with ihis permit and current Cily ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you di9. TOLL FREE NUMBER 1•800•424•5555. <br />Approved lor ConsUuclion Date <br />FINAL INSPECTION <br />Approved as Constructed <br />evemtt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Fhone:253�8815 <br />� <br />� <br />W <br />F- <br />�w� <br />� / <br />� <br />0 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneUapplicant hereby agrees to huld and save harm� <br />less the City ol Everett Irom any and all claims lor damages, cosls, <br />expenses, or causes of action that may arise because of installation <br />and mainlenance o! the improvement or olher right-ohway use he�elo <br />applied lor antl further agrees to removr. same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Date <br />Si�naWre of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO <br />8E DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED 8Y THE CIT}' UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />1 <br />J <br />J <br />-,r <br />