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� <br />TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl. WA 98201 259•8810 <br />��.'✓ =-� `i 8 — G I O <br />�ity <br />Describe Propased Work _,�'Q r <br />PROJECTADDRESS(ifknown) 2�-30— �otu, <br />Date �� % Q _ j <br />Public Works Permit p �� ¢ <br />Building Permit # _. <br />Public Works Fee $ ���� L�8 <br />��X� y�S� 33S• 8/6 < <br />��P Phone <br />Z�P Phone <br />n � <br />,Q _,_.. <br />__.. <br />Attach tour (q) copies of plans for proposed work - Draw to scale and note the following if applicable: '� - <br />•Property Lines •putline and dimensions of all existing and proposed structures on the Iot •Existing and proposed utliitles � � <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />_ . ----�-----'- ....,,���.� <br />1. All calls for inspection sh2;i U�� made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertorrried in accordance with this permit and current City of Everett Design and <br />Construction Standarr�s and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />� �O� siJa�C Be �aSreC G✓Ii� �i /Ylin�/rir�M D�' <br />� " o,�' � � • �/ / / <br />^ C 4S5 � CzS�D.�jal� Ol�er 7�� O� C/+US`7Cd Y'OC/� , <br />$, l�r�vecu� ehfr4„ce -fo lof r»�sf [Se cons�u�td <br />per c��y s7�-�;.;dard 307 or ,:�s rhdr�;'�;ed Q7� fhe <br /><o�irecf�oh Of' `f�jC C�{!e O� E,v�rL 1� .f�v.E!tiit CdOrrE'-r �S�lCfoee , <br />Carc� 4�{ac�ieo�� � <br />�, � �'� .,E'� ds ��.�, � �„ ��Q.,.�.:. <br />Dcr q�fa�c�cd�pL2n. � <br />■r� <br />�G <br />/� <br />E� <br />cn <br />tL <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undereigned owner/applicant hereby agrees to hold and save harrless <br />the City ot Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenanca of <br />the improvement or other rtght-of-way use hereto applied for and further agrees <br />to remove same upon notice (rom the City and to replace public property <br />damaged thereb . <br />Signa re of pplicant � /O �� <br />Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PEfiMIT IS ISSUED AND THF.REAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPCN ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. ` <br />Y� <br />