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Date <br />Application For <br />PUBLII': WORKS PERMIT <br />Print or Type Only <br />PUEIICWorkaPormit+r �Z 3�S � <br />emq. oeo�. + <br />Public Works Fee s <br />Tolel Fee � <br />Less Apcl Fae PeiO S <br />Balence0ue i__ <br />City of Everett - Pinehurst Neiqhborhood Association _ <br />Owner Mailing Address Ciry Zip Phone <br />Steve MacNeill <br />1919 Monroe Everett, WA 98203 355-8951 �cT6 �(p <br />c��v <br />Nhone <br />� . ' �•� �- .t�• ���� : • �i �• � u� � • �' �. �. , <br />1- -� .�� � �� .�� i�. � ��� � ��I -�. •1 � <br />Project Address (iF known) <br />Attach four (4) copies of plans for proposed work • Drew to scale and note the following as applicable: <br />• Property lines • Centerline of street <br />• Outline and dimensions of all ezisting and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exi;�ting end proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inapectlon shell be made 24 hrs. In advance - phone 259•8810. <br />2. All work ahall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standerds end Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•500-4245555. <br />� � /-�S /�►- a f�re� � �a� da-{�.d /0-Z 3 -91� <br />Approved as Constructed <br />/A�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259-8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />• <br />H <br />� <br />0 <br />a <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because ot installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City an to rep�ace public property damaged theieby. <br />� � - % � /4 �14--2? <br />Signzture of Applicant Date <br />WORK AUTHORIZED BY THIS P-FMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT '.S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANl' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATIUN. <br />