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Date P � B� <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typs Only <br />Mailing <br />Public Wa�ks PermOii • ��— ��/�/ <br />BItl9.�epl.s U� �s�/� <br />PUEIIc Woeks Fee <br />Total Fee $ —� <br />Lesa ApoL Fee Pnid $ �r� <br />BalancaUus $ C� <br />Phone <br />S9mc� — — <br />Applicant Mailing Adtlress Ci�y Zip Phonr. <br />Describe Proposed Work COiG'.fT.Pr/GT �.S'iit/GGE FA�.�.c fi /PES��F/UL� <br />. <br />Prolec� Address (if known) <br />Attach four (4) copies ol pians for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property L�nes <br />• Outline and dimensions of all existing and <br />proposed structures on ihe lot <br />• Existing and proposed utililies <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading chan�es <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • ph�ne ?.59•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />j/ .Lf.o�L/G�ti� /S To CONi=.GG�m ?�/�/ii <br />SEcc.�E.e TO 220Z-� /n�9UisON �S ln •� <br />/� Ti�E ���b'ciG .�iGHi - U1r- ��i�y <br />/ <br />T//E SivE <br />DiilmE.-r.E <br />,S �� �S�iO SEuJE".2 �'iZd /.r (o ��Dif.+, T//E fii�f�� /lAn/% <br />Gvi�C .dE r9«ow�o 7o C[Jti.c�EC7' T.c� .vE� se:wE,e <br />FU2 Zc�•OB-/7'/HDiSOn/ /NTO /� /�i�'DY�O�J f,�E .DOE-r TNE <br />fOCto<<-i,uG � /, ���u5•-i'ucr A Tf �PE- / m�ti/fct�" PE.e ci!'f/ <br />ST�iJNO/�.fl� f�,CJS 'qi Tf/E L��XrE �F �NE �PO.UJ, AND <br />�'iY,P�'�u�G ZT Fo�c' Bo7// S�DE SEt✓E2S, <br />2, t3G�,��'rA.v EASEinE�c'�r � o T//r C�/ Cn2'JT� CTEL� oN <br />�F T�.E /3?oPosFo t'va ACK OW� �G MI NT OF CONDITIONS <br />everett PUBL�C WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, N�A 98207 <br />Phone: 2'i9-BB! 5 <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold anJ save harm- <br />less the City of Everett trom any and all claims for damages, costs, <br />expenses, or causes of aclion thtit may arise because of installation <br />and maintenance ot lhe improvement or other righl�ot�way use hereto <br />applied for and fur�her agrees to remove same upon notice Irom the <br />City and to replace public property dama9ed thereUy. <br />c� r�.�-, �f� ���ri� <br />ignalure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED Wli-HIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY P:'qSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE �ITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOtJ. <br />