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(, <br />Date_L_[ � - n �i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Address <br />City <br />pu�4cWorNSPermi�a __�!�� <br />BiCB� Dept. • <br />PublitWorksFea A�� <br />Tolal Fee $ L <br />LP59 Appl. F!P Peld $ �/_ <br />Balance Due $ ��� (� � <br />Phone <br />. - • ... - �6V.�i'e:■ �ir .�//id111fY��i�i+�l:a17�1�'�i1�T[�'�i <br />■4 �. <br />Project Address (if hnown) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions of all existing and • Indicate North <br />. proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. AII work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br />Stendards and Specificatlons. <br />3. Call Location Underground 3ervice 48 hrs. belore you dig. TOLL FpEE NUMBER 1-800•424•5555. <br />�. %�� a f�o �-- � �D lc:r�5 O"�tt��s� /d "zz- E� � <br />npprovea as Gons�rucrod <br />evere[t <br />e. <br />PUBLIC WORICS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby ag�ees to hold and sav? harm- <br />IPss the City of Everetl Irom any and all claims for damages, cosls, <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance of the improvement or other right�of-way use hereto <br />applied for and further agreps to remove same upon notice trom the <br />City and o,r e public property damaged thereby. <br />\ t t�� "7-/�, 5�:�� <br />Sign ture of Applicant ''� Date <br />WORK AUTHORIZED BY 1�HI5 PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUFD AND THEHEAFTER IS TO <br />BE D�LIGE�TLY PURSUED Tq COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />