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Date�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />3�z- <br />Owner <br />Maiiin9 <br />Describe Proposed Work <br />Zip <br />� <br />PuEbc Wo�ks Permil � �" _ ��� <br />eiag. 000�.• �85In1^ <br />Puonc wo�ke Fae s <br />Toiel Foe <br />Lass ApP� Fea PaiA S <br />BalancaDue S ��� <br />Pro�eci Addreas (il known) LJ � l�r � '-'� •" <br />Attach faur (4) copies of plans for proposed work - Oraw to scale and note the following ns applicable: <br />• Property Lines .• Centerline of street <br />• Outline and dimensions of all existing and � Indicate North <br />proposed structures on ihe lot • Show any Proposed grading chenges <br />• Ezisting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />t. All cells for inspection shall be made 24 hra in advance - phone 259•8815. <br />2. All work shall be performed in accordance with tliis permit and current C�ity ol Everett Design and Construction <br />Stenderds and Specificaliona <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL PREE NUMBER 1•B00•424•5555. <br />�I , �J (ly LL5 �2- �C) ���� < S�OU�2�. <br />,vpprovea as �onscruceea <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDCEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages, rosts, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of t e improvement or olher right-ohway use hereto <br />a 'ed tttf���or and fur e grees to remove same upon notice irom the <br />C a a� replace b roperty damaged thereby. <br />\ <br />. �� <br />Signature of Applicant Date <br />WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF VlORK nN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />