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Date �� "�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />�� <br />Address <br />c <br />Deacribe Proposed Work � R�i�� /, � 1��. •. <br />Pro�ect Addresa �il known� <br />PubLc Wmts Permit+ . _ `� `_ ' � <br />BIOg. Dept t � <br />Peeuc Works Fee <br />Tolal Fee s <br />lece ApD. Fee PaiE S <br />a,�,��, o�, s Ss 4/� <br />Phone <br />Z�P Phone <br />Attech four (4) copies ol plans lor proposed work - Draw to scale and note the following as applicable: <br />• Properfy Lines <br />• Outline and dlmensions ol all existing and <br />proposed structures on Ihe lot <br />� Existing and proposed utilities <br />'. Approved as <br />everett <br />• Centerline ol slreet <br />• Indicate North <br />• Show eny proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1 All calls for inspeclion shall be made 24 hrs. in advance - phone 259-8815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Stendards anJ Specitications. <br />3. Call Locatlon Underground Service 48 hrs. belore you dig. TOLL FiiEE NUMBER 1-800•424•5555. <br />'7� /--Q'✓ CY�GJ� �„f d��CI�. s der�c� '¢-.�a - Qi� <br />i <br />PUBLIC WOiiKS DEPARTMENT <br />3200 Cedar Street <br />E��ereft, WA 98201 <br />Phone. 259-887 5 <br />�� <br />Date <br />�O 1,✓ % <br />ACKNOWLEDGEMENT OF CONDITIOYS <br />W <br />� <br />e� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hcreby agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that mry arise because of installation <br />and maintenance of the improvement or other right-ol�way use hereto <br />app�ied for and f h grees to remove samr. upon notice from Ihe <br />Ciry a+�d)o replaCe �"�perty damaged thereby. <br />WOFIC AUTN�IZED BY THIS PERMIT MUST 8E STARTED WITHIN <br />180 DAYS Q DATE-PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUP,SUED 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 />