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� � � <br />H <br />Q � <br />H�Ah� <br />p r�1% <br />'�C H 'pa1 <br />VJ H <br />�O�OM <br />H�g <br />QY (] <br />t"H� <br />t� y <br />fA <br />C]�W <br />�O� <br />� <br />t <br />I, � � <br />Date ��. �� <br />qppliCation Far <br />PUBLIC WORKS PERMIT <br />Print or T;�pe Only <br />�V PuEI�c Wo�xa Pe�mil � � J� <br />BIe9� oeol � 9r�- <br />Vu01¢Wa�wafee 5 <br />ic1��Fee <br />Lu� �DGI Fee Pa,] 5 <br />Baiance Oue <br />Ciry <br />Descri6e Proposed Wark <br />Prolect Address lif known) <br />Attach lour (4) copies of p:ans lor propased work - Draw to scale and note the lollcwing as applicable: <br />• Propetty Lines <br />• Outline and dimenslons ol all existing and <br />praDoSetl SlruGtures o� Ihe lot <br />• Existing antl proposed utilities <br />• Cenredine ol street <br />7P Indicate Norih <br />• Show any proposed grading chan9es <br />• Show meeSufement5 <br />PERMIT CONDITIONS <br />1, All calls lor inspection shall be matle 24 hrs. in advance - Phone 259�88� 0. <br />2. All work shall be peAormetl in accordanca with Ihfs permit and current City of Everett DesiSn and Consiruction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•�00'424•5555. <br />� ��� �� -� � •.: .f <br />�7_,� %� �v�=/-�-��u� � e� <br />. -�(n�, <br />/ <br />� i!-i/ <br />qpprovnd for Construction <br />� �ale <br />Date <br />FINAL INSPECTION <br />APOroved as Constructed <br />�A��PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259�8810 <br />� <br />� <br />i <br />Z <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned ownerlapplicant hereby agrees to hold and save harm� <br />less the City ol Everett irom any and all clains for damages. costs. <br />expenses, or causes of action that may arise because of installa[ion <br />and maintenance of the improvement or othar right•ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Ciry and to replace public property damaged thereby. <br />Date <br />Signature of ApPlicant <br />WB FD YS OFRDATE FERMIT ISEISSUED AND THEREAFf�E�R ISHTO <br />BE DILIGENTLY PIIRSUED TO COMPLETION. THIS PERI�IT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPA6E OF WORK ON THIS <br />PRO.IEG' OVER 90 DAYS DURATION. <br />