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Date 6-2-tt -il <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�l'6-LLI�`OuJ��,1t `t.4Yr <br />Public Works PalmIt* �3 1 f <br />Bldg. Dept. a n �/ /? Q 10 <br />Public Works Fee r1OUu <br />Total Fee S �r <br />Less Appl. Fee Paid S <br />0 <br />Balance Due $ <br />1$Zo3 <br />ZSZ-yo3-7- <br />Owner Mailing Address City Zip Phone <br />Su.t" z <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Uly.L-' 4,,, cd— <br />Project Address (if known) <br />0 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the folldwing as applicable: <br />• Property Lines <br />• Ce iterline of street <br />• Outline and dimensions of all existing and <br />• InJ" :.te North <br />proposed structures on the lot <br />• Shuw any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Cl.nstruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />J. 51c+e Sewe! -et att be (.'r .4. blA:�, <br />jjtructions-.z-3, <br />r d f r Irk` — �I��b Date <br />pprDvA as Constructed ( \ \ <br />everett PUBLIC WdRS/DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />W <br />H <br />O <br />z <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />apfjlied for and further agrees to remove same upon notice from the <br />Gitiand to replace puAlic property damaged thereby. <br />W R AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18 VS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />