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Date�`� <br />Application For <br />PUBLfC WORKS PERMIT <br />Print or Type Only <br />Address <br />Pu�lic Warks Perm�it • `-' S� /�" <br />amo. oeo�.• �r 3 3� <br />Public Wa�ks Fee S <br />Tolal Foe — <br />Le39 ApP� Fee PBid S n <br />Belanca 0ue S «Or 0� <br />�k89/ <br />r��s .�+✓Cd � ,'�:.'�� g�ZC� � ZS�' -`l / / � <br />City Zip Phone <br />, � <br />,�Sf�J�;rs ��4�5"� �.3�/'`/73.3 <br />City <br />Nhone <br />Describe Proposed Work �`-�-� v�� — <br />Prolect Address (if know�) <br />Attech four (4) copies of plans for proposed work • Draw to scale and note tho following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and � Indicate North <br />propoeed structures on the lot � Show any proposed greding changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advence • phone 259-881 5. <br />2. All work shall be perlormed in accordance with lhis permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Locelion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />f; SEF+.n�eArF CU•c6 CVT ir��� dE /v�dvE fo,E TN/S <br />.C'ESFOE�/CE' OFf T�� ENO �%f� TNE Ci/C-p� SAG � <br />,S SEWEi� AND G✓�TE°.L SE/1l�icES N9rlST dF INSTd LCFJJ <br />J�.n2HL�EL An/V Dff Of THE C/>y �'O,CJ, iHEN <br />J�Eti�'e�/��C�<e� To TyC ST,�FEr DVE,�' To TNG- /�NN , <br />Approved lor <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-Bfi 7 5 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to ho�d and save harm- <br />less the CRy ul Everett trom any and all cla'ms for damages, costa <br />expenses, or causec ot actio� that may arise because of Installetion <br />and maintenance of the improvement or olher right•of-way use hereto <br />applied lor and further agrees to remove same upon notice irom the <br />Ciry and to re lace public properry damaged thereby. <br />t <br />\ <br />Sig ature o Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF D:.TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY'�'URSUED TO COMPLETION. THIS P[RMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />