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�r�t�.��J � <br />Application For <br />PUBLIC WORKS PERM17 <br />Frint or Type Only <br />Pu01m Waiks Parmil a ��� ��� <br />diEg Depl. • �%� <br />Pu01ic Works Fee <br />TolelFee $ <br />Lesc FOP� Fee Paid � y <br />Baianca �ua $ P�- <br />��I�GK/z <br />Applica� Mailing Adtlress City Zio Phone <br />Descrite ProFosed Work �_. .� (��([2 �'—��l�-!-;-.r r%G 0 f� �� /� I/P Lt /��__ , <br />J <br />Piojecl Address (it known) '"���n! �—��� <br />Attach four (4) copies o( plans for proposed work - Draw to scal= and nole ihe toiiowing as applicable: <br />• Property Lines <br />• Outline and dim=nsions of all existing and <br />proposed structures on thc lut <br />! Ezi:iing and proposed utilities <br />PFRMIT CONDITIONS <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show meas�vemerts <br />1. All calls for inspec�ion shall be rnade 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in acwrdance with this pormit and current Ciry of EvereL' Desi�n and Construction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBFR 1•800•424-5555. <br />����� /��/� <br />Approved br Conslruction ate <br />_'���i`a�-� /-� 7-�7 <br />FINAL I SPE ION Oate <br />Appr•�ved as Cons�ruded <br />e�rerett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:252-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undcrsigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City of Everett Irom any and all claims for damages, cos�s, <br />expenses, or causes of action lhal may arise because ol installation <br />and maintenance ol the improvement or other righFof-way use hereto <br />applied lor and lurther agrees fo ramove same upon notice from ihe <br />City and to replace public property damaged thereby. <br />r <br />���L��au�r � � —�� <br />Si,r,nature ol Applicanl Date <br />WORK AUTHORIZED BY THIS PER!AI UST 8E STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'/ BE <br />CANCELLED BY THE CITY UPON ANl' STOPPAGE OF WGRK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />