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Date.JL��s�� <br />PUBLIC <br />Print or Type Only <br />Applicalion Forv <br />WORK�PERMIT <br />Q <br />O <br />O f� <br />� O O O <br />� ao m <br />ui : � <br />Pu�Lc Worhs Pormit • �'�I �/ ���` � <br />BIdB OePI. • ��-i3,1(f----- <br />Publ¢\YortSFce 5 /�� / <br />Tolal Fee --� <br />Less ApO� Fee Paid $ �/j---- <br />0aionce Due $ <br />�,%/ <br />Describe Proposed Work `t�n� a 1� )�/ U ru�(�1'�`LO�e l <br />Prolect Address (il known) - � — — - <br />Attach four (41 copies of plans lor proposed work - Draw to sca e and note the following as applica6le: <br />• Properfy Lines • Centerline of sireel <br />• Oulline ar�d dimensions ol all existing and • Indicale North <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� .�►- ��y���.�,s- �.� �^�� -�� <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Stree! <br />Everett. WA 982J7 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />F <br />N <br />O <br />a <br />The undersi9ned owner/applicant hereby agress to hold and save harm- <br />less the Cily ol Everetl irom any and all claims tor damages, costs. <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance of the improvement or other right-ot-way use hereto <br />applied lor and furiher agrees to remove same upon nolice Irom the <br />City and to replace public property damaged thereby. <br />S� alure of � pplican Date <br />WORK AUTHORIZED BY THIS RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9G DAYS D'JRATION. <br />