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�, <br />TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS �ERMIT <br />PUBLIC WCRKS DEPARTMENT <br />3200 Cedai Street <br />Everett, WA 98201 � , - a0 <br />� -; ���'����i ocT o s �ss� <br />_C�-� J.�l�;s�, P r�� <br />Owner Mailing Address <br />Applicant Mailing Address <br />Describe Proposed Work <br />�z <br />UU <br />PROJECT ADDRESS (if known) 2� <br />///��l / <br />Cate �! / I { _ <br />Public 6Vorks Permit k _ �7J_lV � <br />Buildiny Permit # _ <br />Public Works Fee $ _��'4 . � _ <br />C� � y�/1 C6 % <br />Attach four (4) copies of plans (or proposed work - Draw to scale and note ihe following if applicable: <br />� <br />Phone <br />•Property Lines •Outline and dimensions o( all esisting and p�oposed strucwres on the lot •Existing and proposed utilities <br />•Centedine of street •Indicate North •Show any pmposed grad�ng changes •Show measuremenis <br />._ ..___..._ <br />PERMIT CONDITIONS: <br />1. All calls for inapection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall 6e performed in accordance with this permit and current City of Everett Design and <br />Construction St�ndards and Specifications. <br />3. Call Lc,cation Underground Service 48 hrs. before you di�. TOLL FREE NUMBER 1-800-424-5555. <br />`�� �s �� ��pti�d�ol� � ��� �� �i7 <br />.,-;''1:..'�% <br />/ <br />l�,�0�710� <br />n��R <br />'+.e'V <br />,',`F>S <br />- .���, <br />7��'Or ' _ . . ., <br />`�JO ' <br />50� - <br />'6�r'.,. <br />W <br />� <br />� <br />v/ <br />W <br />O <br />� <br />ACKN06VLEDGEMENT OF CONDITIONS <br />The undersigned owner/appiicant herehy agrees to holtl and save harmless <br />ihe City of 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 />ihe improvement or other righbof-way use hereto applied far and furiher agrees <br />to remove same upon notice from the City and ta replace public property <br />damaged thereby. � <br />j % � <br />Signature� e <br />WORK AUTHURIZED BY THIS PER�dIT MUS7 BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE �ILIGENTLY PURSUED TO <br />COMPLETION. THIS PERM1IIT MAY BE CANCRLED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />