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Date� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />Project Address (if known) _ <br />Attach four (4) copies of plans for proposed work - Draw to scale a <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on ihe Iot <br />• Existing and proposed utilities <br />PuElit Wo��a Peimi <br />Bldg Deo��+ <br />Pubbc Worka Fee <br />Total Fee S <br />Less AOP� Poc Peid S <br />Balance Duc S <br />c�ry <br />fhe following as applicable: <br />• Centerline of stre?t <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All cells for inspectfon shall be mede 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 �ocation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•B00•424•5555. <br />��i%/�J�'u�[ <br />���� <br />�'��" _ <br />�,��� <br />The under: <br />ICSS ihC C <br />cxpenses. <br />and mainte <br />applied tor <br />Approved for Conslruction Date City and to <br />FINAL INSPECTION <br />Approved as Consirucled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />� Everett, WA 98207 <br />P��one�. 259�BB10 <br />� <br />Qe` f � <br />�, n � <br />�,8 <br />� �,,-- ���� <br />��°� 1- <br />J�a n�l <br />/ ����� � � � <br />�.,Zlti"'. <br />�.C. G E <br />R�• � <br />W <br />H <br />� <br />harm� <br />Co5�5, <br />Ilation <br />,e�e�o <br />m the <br />Signalure ol Applicant Oa�e <br />WORK AUTHORIZED BY TIiIS PERMIT MUST BE STARTEI� WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUEU AND TNERE�F��ER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS ?ERM�T MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />