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Applicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stree� <br />Everelt, WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY <br />Mailing Address <br />Describe Proposed Work <br />PROJECTADDRESS (if known) <br />� <br />Date �`��� <br />Public Works Permit H � <br />Building Permit � <br />Public Works Fee $ � <br />�.�.�isc.� �� <br />Zip Phone <br />Attach lour (4) copies plans tor proposad work • Draw to scale and note Ihe following il applicablc: . � <br />• Preporty lines • Oulline and dimenslons ol all existing and proposed slructures on the bt • Evisting and proposed utilities ;; �� <br />• Centedine of street • Indicate Noeh • Show any pmposed grading :hanges • Show measurements . <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8d10 <br />2. AII work shall be performed in accordance with ihis permit and current Cit; of Everett Design and <br />Construction Standards snd Spc;cifications.. <br />3. Call Location Underc�round Service 48 hrs. be(ore you dig. TOLL FREE NUMDER 1-800-424•5555. <br />�� ��f;�-� h�d� �:�►K5 f Gvr�JS w,-L'�, i����ok �lywa�d <br />5. <br />� <br />W <br />� <br />� <br />V / <br />� <br />Q <br />� <br />V / <br />� <br />W�� -Lr1-e Vvh�Ll.� w�ll � dV'iV�✓�(� ol/� 5;dG1�-hl �� � <br />No he�vc� clvf�j -�,,�ks �� �ow� —�,z�—v� +��k o�ly. <br />G/r�j,9�r� S 5ideu�(IC � ike?''�i iz �ew ��d c,v� �hM��d - <br />�h�d�rh�o� �l-criGiv 5�a61 bZ ►�t�1r�d cV c�-cPh�cec� � co� }r,�c�a✓: <br />lFi is v���ss��y� dr�ll �Inrzi,r��t x 5;�cw�llc �nol --�����c. <br />�u�1�� eXpliNs��+ Jol�t-�-o-erPa.��s� o.��jo;n� n,�s� � r-emout� aµd rtPluce�, <br />�se a pPro,p�h tx' �v��s z.nd �f»� S+rv� �� o� �f�e�� 5; y� s. <br />ACKNOWIEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo holU and save harmless <br />the Ciry of Everett irom any and all claims for damages, costs, expenses, or <br />causes of action that may arise because ot Installation and maintenance of the <br />improvement or other right-oi-way use hereto applied tor and further agrees to <br />ramove same upon notice from ihe City and to replace public property dam- <br />VJORK AUTHOR�D BY T}iIS PERMR MUST BE STAqTED WfTHIN 180 DAYS <br />WMPIFfION. THIS PERMfT MAY BE CANCELLED BY THE CfTY UPON AN'I STOPPAGE OF WORK ON hilS PRQIECT OVER 90 C 4ti'S W HAT10N. <br />