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Date__[_,L• �/O � <br />/ <br />Application For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />l / � CaL�;y <br />Mailing Address <br />;�3z�iy"���� � <br />Mailing Address <br />Describe Proposed Work �"'���� S v��G �� <br />Prolecl Adtlress (if known) <br />sT�ve�+s � <br />Zip <br />vom��c worxs vanni� . �� <br />eiac n�o� . �� // 90/ <br />Puor�cWor�sFee s .� p <br />Totel Fee <br />Leat Apo� Fee Pe1E S <br />Bale+ce Due 5 � <br />Atlach lour (Q) copies o� Plans for proposed work- Draw to scale and note the Iollowing as app��cable: <br />• Property Lines • Centedine o� street <br />• Oulline and dimensions of all existing and • Indicate North <br />proposed structures on Ihe lol • Show any proposed qrading changes <br />• Existing and proposed utirties • Show rt:easuremenis <br />PERMIT CONDITIONS . <br />t. All calls for inspection shall be made 24 hrs. �n advance � phone 259•881 5. <br />2. All work shall be pedormed in accordance with this permit and current Ciry of Everet: Design and Constmctlon <br />Standards and SOecilications. <br />3. Call I.ocation Underground Service 4B hrs. before you tlig. TOIL FREE NUMBER 1-800•424-5555. <br />Approved as Consiructed I 1 � <br />\ I <br />everen PUBLIC WOF71C5 DEPAPTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 90201 <br />Phone:259-8875 <br />-Z � <br />ACKNOWLcDGEMENT OF CONDITIONS <br />� <br />W <br />H <br />�w <br />_/ <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersignetl owner/applicanl hereby agrees tu hold and save harm- <br />less the City ol Everelt irom any anC all claims lor damages, costs. <br />ezvenses, or causes ol action ihat may arise because of installation <br />'and maintenance ot the improvement or other right-ol•way use hereto <br />apPlled lor and lurther agrees to remove same upon notice from Ihe <br />City and to replace public proper� maged ihereby. <br />��G' L � ` / <br />� <br />SiGratuB ot AnPlicant Date <br />WONK AUiHOR12ED BY THIS PERMIT MUST BE STARTED WITHI� <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLED OV THG CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATIJN. <br />"1 <br />1 <br />� <br />J <br />� <br />