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Date1��G�v7' <br />Applicalion For <br />PUQLIC WOR;4S PERMIT <br />Print or Type Only <br />Appifcant <br />Describe Proposed Work <br />�• i� <br />Prq�ect Address (if known) <br />Malling Address <br />l!i <br />SG <br />Ciry <br />PuClic Worke Permil � __ �`�'%� <br />/ <br />61dp. Depl. • <br />Publit Wurk9 Fae z�� <br />.o�a� Faa s <br />Leee AOGL Fee Paltl f <br />Balen<e Due S �Z'Z� <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the lollowin§ as applio�b�e: <br />• Prope�ty Lines • Centerline oi siroet <br />• Outline and dimensions of all existing and i Indicate North <br />proposed structures on the lol • Show any proposed grading changes <br />• Existing and proposod utilities � Show me2swements <br />PERMIT CONDITIONS <br />:�T'�` 6T.'�� <br />5 317-��,f <br />Phone <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work sfiall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Speci(ications. � <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />'T• Y�'�/ c li'✓6i-/�s .t�-�-e�.�Ci �,�i�/ r�j- �; �--c- <br />,E✓USr or. �n�+ O�u'c � r.r//�-�n /�..e c-�PSS�/ <br />/ i •�•/ <br />�� . 'T/�,'s `Q/c"r'- a.Y, �%rin.�� ,s u,� c/�.l,�ipS <br />��. <br />,� �O <br />Dat <br />Approved as Constructed v \ <br />everett PUBLIC WORKS DEPARTM <br />� 3200 Cedar Street <br />Everett, WA 90201 <br />Phone:259-8815 <br />AGKNOWLEDGEMENT OF CONDI710NS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett trom any and all claims lor tlamages, costs, <br />er.penses, or causes of action that may arise because of installation <br />and maiNenance of the improvement or other right-ohway use hereto <br />app!ied for and further agrees to remove same upon notice irom the <br />City aq� to replace public property damaged thereby. <br />Sic�natu of Applicant Date <br />WOR AUTHORIZED BY THIS PERMIT MU5T BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTcR IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 9E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF VJJRK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />