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Date�j�`� <br />ApPlir,alion For <br />PUBLIC WORKS PERMIT <br />Prin! or Type Onl;� <br />Mailing <br />City <br />City <br />Lp <br />Zip <br />Describe Proposetl Work �.(Gi% S/IZJ�---/�— �--b3.��-� G-� -� y'f � <br />Proiect Address (il known� �E"� � — <br />Attach four 14) copies of plans for proposed work - Uraw to scale and note the following as applicable: <br />• Property Lines <br />� Outline and dimensions ot au ezistin9 and <br />p�oposed structures on the lot <br />• Existing and proposed ulilities <br />PubLc 1vo�A. Peimil . � r �� � <br />a��� o�P, . ��� � 7_33� <br />PaencWmAsice S <br />Totai Fee <br />Less Rnpl Fne Pn�� �u��/��/�v <br />�alanc<Dua S �—�/� <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measureme'..�5 <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance - phone 259-8ii10. <br />2 All work shall be pertormed in accordance with this permd and current City of Everett Design and Construction <br />Standerds and Specifications. <br />:i. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CetlarSlreel <br />Everel6 WA 99201 <br />Phone: 259-BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold antl save harm- <br />less Ihe Gty ol Everetl Irom any and all claims lor damages, co5ts, <br />expenses, or causes ol aclion that may arise because ol installation <br />and maintenance of the improvement or other right�ohway use hereto <br />applied for and further agrees to remove same upon notice irom Ihe <br />City and to replace public property damaged thereby. <br />�`IX�`.fl/ �C') �LCc � � .�U-8 % <br />SI9naWr f Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MP.Y BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURA710N. <br />