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Date (�-\2-� j <br />Appllcetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />w <br />Address <br />Deacribe Proposed Work <br />Pro�ect r.ddress (il known) <br />PUEIic WorMs Parmil � � <br />emc. oeo�. • <br />PubllcWodeFea � <br />Tolal Fee a � � u <br />Lees Rco� Fae Pe�tl S <br />Bolenee Due f �' � � <br />_ � <br />—�;..�-� `/�i iC� % �=� %- % %� � <br />City Zip Phone <br />�S� �_��,:� rJ �;Y�,�� ��� � - ��i�� <br />City ZIP Phone <br />�..J Q(�vlw.e.i. C� <br />Altech four (4) copias of plans for proposed work • Draw to scale and .iote Ihe following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimansions of all exisling end • Indicatu Nortli <br />prop�sed structures on ihe Iot • Show any proposed grading chenges <br />• Existing and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs In advance • phone 259•887 5. <br />2. All work shall be peAormed in accordance with ihis permit and currant City o1 Everett Design and Construction <br />Standerds entl Speciflcatinns <br />3. Call Location Undergrountl Sarvice 46 hrs. before you dig. TOLL FREE NUMBER 1•800•424•55SS. <br />� w�.A�l�1MNw- �i•v�wn� W.cl�h � �� �/ <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everett, WA 98201 <br />Phone:259•8815 <br />� <br />O <br />�Aw <br />_I <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicent hereby agrees to hold and save hern�• <br />Ipss ihe City ol Everett Irom any and eil claims for dameges, costs, <br />expenses, or causes of action ihat may arise because ol instellation <br />and maintenance oF the improvement or other right•oi�wa'1 use hereto <br />�� applied for and further agrees to remove same upon notice trom the <br />ate Citv and to rep�ace publi5,proper,yy damaged thereby. <br />Lo. <br />vyuRK AUTHORI2ED BY THIS �ERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT�S ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 9Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />., <br />"� <br />_� <br />.� <br />I1 <br />J <br />