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Date J � �� • <br />Application For <br />PU�LI� WORKS PERMIT <br />Print or Type Only <br />� � ��,��� . �) �, �ii.3 -�?.� 2, cJ <br />Owner Mailing Addre�s City <br />Applicant <br />Describe Propos=,i Work <br />Project Address (if known) <br />Mailiog Address <br />• Public WOY s Par It > � G��` <br />eiaP. oeo�� * � <br />cuolicwaeksFee $ <br />To1al Fee <br />Less f 00� Fee'•aid � <br />Balance Duo $ �d� �� <br />`/�/.�S 3 <br />�3.r,f-J d� <br />Phone <br />Zip Phone <br />Attach four (4) copies of plans for Nroposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />praposed structures on �he lot . <br />• Existing and proposed utilities <br />Approvedfor <br />• Centerline of street <br />• Indicale Norih <br />• Show any proposed grading changes <br />• Show measurements <br />11:1 <br />PERMIT CONDITIONS <br />1. All calls fnr 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 cwrent Ciry of Evere�t Design and ConsVuction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />-3-�� <br />Date <br />pp.ovea as consaucieo <br />evemtt PUBLIC WOFKS DEPARTMENT <br />� 3200 Ced2r Sireet <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITION� <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant hereby agrees to hr;d and save harm- <br />less the City of Everetl from 2ny and all claims Wr damages, costs, <br />expenses, or causes ot aclion ihat may arise b�cause of installation <br />and maintenance of lhe improvemenl or other ri�hbof-way use hereto <br />applied for and further agrees t re ove same �uon notice irom Ihe <br />City and to rep�e pyb�ic yro rty d ryaged ihereby.,\ <br />Qi <br />io ,g� <br />Date <br />WOHK AUTHOF7t`LED BY THIS PERMIT MUST BE STARTED �'JITHIN <br />180 DAYS OF DATE PF_RMIT IS ISSUED AND THERFA�TER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH!:, PER�11T MAY BE <br />CANCELLED BY TH[ CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFlOJECT OVER 90 DAYS DURATION. <br />