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Date.1.�15� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br /># <br />Pu01ic Works Parmit r _���_ -�9 7 <br />a� ao,.. � <br />PUGIic Wnrks Fea <br />Tolal Fee s _ —� <br />Less Appl Fee PBid S_�YT� <br />Balance�ue S Z�uv <br />Describe Proposed Work i%�l ���/c— �,i�T Y __ <br />Pro�oct Addresa (if known) (� �/� — <br />v <br />Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following as applicab�e: <br />• Propery Lines .• Centerline of street <br />� • Outline and dimonsiona ot all ezisting and • Indicate North <br />proponed structures on the lot • Show eny proposed grading chenges <br />�� Ezletinq and propoaed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. � All calla for inspection shall be made 24 hra in advance - phone 259-881 5. <br />�'� '. 2. All work ahall be pedormed In accordance with lhis permi: end wrrent City of Everett Design and Constructlon <br />Standards end Specificationa <br />.� � 3. Csll Location U�darground Service 48 hr;�. betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />'Til�,�^Lef/F <br />!%. .f'ol� ToP 1>oc�.c/J"s�ovT.f' i.vTo .l7iQi�i /N.9GF <br />SySr.�..-t � S/�ow.v ac/ Am9Ch'fD Cy.9�eT <br />�pprowa �s <br />evelatt <br />� <br />�,o� !�'-�d' <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everet4 W'A 98201 <br />Phone: 258-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned owner/eVPlicant hereby a8rees to hold and save herm- <br />lass the City of Everett trom eny and all claims for damages, coats, <br />expenses, or ceuses of actlon that may ariae because of instellation <br />and maintenance of the improvement or other right•of-way use hereto <br />applied for and turther agrees to remove same upon notice from the <br />City and to replace public property dameged thereby. <br />� °--=-�-A �� 1 �i 9/� S� <br />Signatute of ADP�Icant � <br />WONK AUTHORIZED BY THIS PERMIT MUST BE S7AR'fED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. �_ <br />