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Date ��""� ,�.� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />f-• <br />Fuobc lvoas Permn �J� <br />Bidg Depl. + � <br />Yubuc Warks Fee <br />Totql Fee S <br />Less ApPI. Fee Paid $ <br />Balance Ouu $ <br />Applicant <br />Describe Proposed Work <br />Proiect Add�ess �if known) <br />Alailing Address <br />Ci�y <br />Atlach low (4) copies ol plans lor proposed wmk - Draw to scale and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outlina and dimensions ol all existing and <br />proposed strudures on ihe lot <br />• Existing and proposed utilities <br />• CenterLne ol streel <br />• Indicale North <br />• Show any proposeA grading changes <br />• SYow measurements <br />Phone <br />PERMITCONDITIONS <br />1. All ca�ls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and curreN City of Everett Design and Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Sen�ice 48 hrs. bebre you dlg. TOLL FREE NUMBER 1•800•424•$555. <br />-i�/�� }�z���� ��ll�i /"�� . <br />' ��.��� ��� ��e� <br />: � � � -����.,, <br />G. (_. J <br />Approved lor Construction <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evcrett, WA 99201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />a <br />H <br />� <br />O <br />a <br />The undersigned owner/applicanl hercby agrees to hold and save harm� <br />less the Gty of Everett from any and all claims for damages, costs. <br />expens�s, or causes of .�r.tion �hat may arise because ol installation <br />and maintenance ol the improvemeni or other rigM-ol-way use hercto <br />applied lor and lurther agrees to remove same upon nofice from Ihe <br />City and to replzce public properry damaged ihereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PENMIT IS ISSUCD AND THEREAFTER IS TO <br />B[ DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPFAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURA?ION. <br />