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i <br />Date � � ���� <br />� Application Fur <br />PUBLIC WORM.S PERMIT <br />Print ur Type Only <br />ACdress <br />City . . . . ZiP <br />P�GI¢ wo�ws Parmn � ___��� <br />� ��. I <br />ema. oeo�� � —:�—� <br />PuolmwakeFee S <br />Tolal Fae �� <br />Leu Appl Fae Pa�E S ��� <br />BabnceDm $ ��— <br />rnone <br />Cescdbe Proposed Work ( �` /j,G ,� / "�l �' � / ' — <br />Prolecl Addrese (if known) <br />Attech lour (4) copiea ol plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Unes .•' anterline of street <br />• Outline end dimensions of ali existing and • Indicata North <br />pioposed structures on the lot • Show any proposed greding changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />I. All cal�s fur Inspection shall be made 24 hrs in advance • phone 259•881 5. <br />2, All work shall be performad in aCcordance with ihis permit and cutrent City ol Everntl Design and Construction <br />Stendards end SpeciL�aiior�s. <br />3. Call Loc;:ion Undergro�nd �ervice 4B hrs. before you dig. TOLL FREE NUMBER 1•B00-424•5555. <br />� <br />as Constructed <br />v <br />everett PUBUC WORKS C <br />� 32Q0 Codar Street <br />Everett, WA 90201 <br />Phone: 259•8915 <br />ACKNOWLEDGEMENT OF CONOITIONS <br />The unCersigned oNner/a9plicant hereby agraes to hold and seve harm• <br />less the Clly of Everett irom any and all cleims for damages, costs, <br />expenses, or causes ol action that m�y erlse becausa of instellation <br />and malntenance ol the improvemnnt or other right-ol•way use liereto <br />applied lor and furlhe� agrees lo remove seme upon notice irom lhe <br />City and lo replece public property Aamnged theie� _ <br />C_ _ ) ' � i;_`�� � <br />/ �' S_. �=-c �.� --. _ <br />Signat�,re ol Applicehl Date� <br />WORK AUTHORIZED 0Y THIS PERMI'f U°T BE STARTED WITHIN <br />180 DAVS OF" DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CIN UPON ANY STOPPAGE OF W9RK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />