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TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />Mailing Address <br />Mailing <br />City <br />Date �61 C17 <br />Public Works Permit # <br />Building Permit # <br />Public Works Fee $ � ZZ - <br />5-0 <br />C? 3-SS- 4aSeZ <br />Lip Friona <br />Describe Proposed Work V7� <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities <br />`Centerline of street •Indicate North •Show any proposed grading changes 'Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />q'r -fy-av-,de,, ie� eroSltv1 Cort-Fitl AS cJ1rCC.e41 {�blTattt,rks <br />IV,rto-lr- <br />S. �.fd work or �,ll ti1 5"Li" oo <br />Cv , �� rid sc1 rtx lr r l ei V1o+ +0 eu Geed 3 rh i q y . <br />W <br />H <br />z <br />0 <br />v) <br />0 <br />a <br />90J, <br />t1Wj I cyntI <br />ACKNOWLEDGEMENT OF CONRITIO -11 <br />The undersigned owner/applicant hereby.agrees tery n save harmless <br />the City of Everett from any and alJ.claApSffofi�em V.l2s, expenses, or <br />causes of action that may arise becfL�_,p�( is oon and maintenance of <br />the improvement or other right-of-way us reto applied forand furtheragrees <br />to remove same upo m the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFI ER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />