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Da!e y•'—� _ '� <br />Application For � <br />P!lBLIG W�R�CS P�RII�lT <br />Print or Type Only <br />Hfailing <br />Describe Proposed Work <br />Prolect Address (if known) <br />Address <br />�o <br />l, � <br />S� � �,� Y <br />� PuOlieWo�kaPetmits �_ // / <br />BICq.Oept y _���yy �� <br />r � <br />Puelic worka Fes <br />l.��al Fea S <br />, leaa ADoI Fae PaiE � � p <br />9alaneeDue $��J //��� <br />Zip <br />Attach (our (4) copies of plans for proposed work - Draw to scaie and note the foliowirtq as applicable: <br />'� Pwperty Ltnes • Centerline of street <br />• Outline and tlimensions of all existing and s Indicate North <br />. proposed structures on fhe lot • Show any proposed grading changes <br />• Existing and proposed utilities � • Show measurements <br />G <br />� <br />��y <br />Phone <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs in advarce • phone 259•8815. <br />2. All work shall he pertormed in accordance v;ith this permit and current City of Everett Design and Construction <br />Standards and Specifications � <br />3. Call Location UnderyrounG Service 48 hrs. 6efore yeu dig. TOLL FREE NUMBER 1•800-424-5555. <br />5� �T-eev C�oZ.� �z`o Gt.e. do�u, ,�'e2 ,a�Z,�i �i , <br />d�-� �-as- -�"°"' <br />8� <br />Date <br />Approved as Constructed <br />evere« PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259•8815 <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herebyagrees to hald and save harm- <br />less the Ci[y of Everett from any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because of�installation <br />and maintenance of the improvement or olher right•of•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />�l <br />WORI< AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS 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 WOFiK ON THIS <br />PROJECTOVER 90 DAYS DURATION. <br />