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Datela���-�U <br />Applicalion For <br />PUBLIC WORKS PEF3MIT <br />Print or Type Only <br />Owner <br />� <br />Mailing Address <br />3 <br />City <br />Describe Proposed Work 7�C/� /-��-Lr!-s--� ��K <br />Project Address (if known) <br />h <br />z�� <br />Atlach four (4) copies oi plans for proposed work - Draw to scale and note the following as applica6le: <br />• Property Lines <br />• Outline and dimensions of all exis�ing and <br />proposed structures on the lot <br />• Existing and pwposed utilities <br />PuOLc Works Permil a n'�, <br />BItl9 Dept+�v"oN/�� � <br />Pu01�r. Works Fee <br />Tatalfen S <br />LesslpPLFeePaitl � <br />Dalance Oua $ <br />• Centerline of street <br />• Indicale North <br />• Show any proposed grading �hanges <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection ,hall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 40 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/'�i/�i� o�Jcr��e2,-.-,-� /�s7�,P��.h.:,� <br />�'/"'�" %�ri�u�-ti <br />I2-/7 �%U <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Construded <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everetl, WA 98201 <br />Phone:259-BB70 <br />Date <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />W <br />� <br />_ / <br />� � <br />� <br />� <br />U <br />� <br />Y/ <br />O <br />a <br />The undersi9ned ownedapplicanl hereby agrees to hold and save harm- <br />less the Cily of Everett Irom any and all claims lor damages, costs, <br />expenses, or causes of aclion ihat may arise because ol installation <br />and main�enance ol Ihe improvement or other right-of-way use herelo <br />applied lor and further agrees to remove same upon notice Irom the <br />City and to replace public property damaged ihereby. <br />Signature ot Applicant Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST RE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DhYS DURATION. <br />