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Date ��� <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Applicant <br />Desclibe Proposed Work <br />Projecl Address (if knownl <br />'�� :'3�TING L�ic� <br />� <br />P�iMIT <br />� <br />O <br />S p p p p� <br />r If] O fj � �] QJ <br />p�'. �} 00 P �1C�1 <br />�.ry M Ifl f.l t�� �Y ^O <br />M w w Cd <br />�... . ` ii N <br />Mailing Address <br />Altach lour (4) copies ol plans lor proposed work • Draw to scale <br />• Property Lines <br />• Ou�linP and dimensions o1 all existing and <br />proposed struclures on the lot <br />• Exisling and proposed utililies <br />PUUIm WorF� Permit • �� O <br />Biae oeoi� • — <br />PubbcWo�waPoe S <br />Totel Fea <br />LessAppl. Fea PeiE $ <br />Balance Oue S <br />� N City� u� Zip Phone <br />So �7wrW<��i <br />f� O�� 3 3 2 <br />N� C] O 2 6. L1 <br />up <br />note Ihe following as applicable; <br />• Centerline ol sVeet <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be inade 24 hrs. in advance- phone 259•8810. <br />2. All work shall 6e performed In accordance wiih lhis permit and current City of Everett DesiBn and Conatruclion <br />Standards and Specifications. <br />3. Call Location Underground Service 40 hrn, before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�, � �ar��� pl�►� ��t�r i�z ���is <br />� <br />Approved as Constructetl �' <br />PUB�. J YJORKS DEPARTMENT <br />3200 Ceder Street <br />Evarett, WA 98201 <br />Phone: 259•8810 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />H <br />� <br />O <br />a <br />The undersigned owner/applicanl herebyagreelto hold and save harm� <br />less tho Ciry ol Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action thal may arise beceuse ol installation <br />aDd maintenance ol ihe improvement or other right•ol•wey use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to eplace public , roperty damaged Ihereby. � <br />L � <br />Signatu e ol Ap icant Date <br />WORK AUTHOR ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS I5SUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />