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u <br />SL <br />.j�r <br />Date_��� <br />PU B�.I C <br />O <br />O <br />O <br />Print or Type Only M <br />N <br />O <br />• H <br />Describe Proposed Work <br />Project Address (if knovin) <br />Applicalion For <br />WORKS PERMIT <br />N N O <br />.-: � o <br />In W O <br />� H <br />. O� N <br />O.r7 � O O O 11� � <br />o ,o c•i .-� ,o t� m <br />N1 N�MO]OOJ <br />w M �N*Ar+P <br />}J1 u! M N <br />City <br />2ip <br />:✓ <br />PupLc WorMs Parmlt � — `�L! .�-Z— <br />eiea o�u�. s �%a �� �%oZ <br />Public WorkS Fco 5 y2 9�� <br />Tolnl Fee <br />Loss AOPI Feo Pam $ <br />ealance Duo 5 Z� <br />Attach lour (4) copies of plans lor proposed �vork • D�aw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing antl • Indicate North <br />proposed siructures on the lot • Show any proposed gratling changes <br />Y Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 O. <br />2. All work shall be per(ormed in accordance with this permit and current City of Everett Design and Constructlon <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />�. �,- �.z,,.�� �, ,r�,s �qr� G -z� �U <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• I <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because oi installalion <br />and mainlenance ot the improvement or other right•of-way use hereto I <br />applied for and turthe� agrees to remove same upon notice Irom the � <br />Ciry and to replace public property damaged thereby. �. <br />$ign ure of Applican � � va�e <br />WORK AUTHORIZE BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAT PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY' UPON ANY STOPPAGE OF WOFIY. ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />