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Date N�� <br />_� . <br />Application For <br />PUBLIi: WORKS PERMIT <br />Frint or Type Only <br />AppliGent mamng ra� <br />Describe Proposed Work �(�1d.W�i'�d�. <br />Project AdAress (if known) <br />cry <br />���y <br />PuOLc \Yoha Permn y/•+{� �_�_/,C/+� <br />plJp. OeoL � �LLYL <br />Public Wa�ke Fne <br />Tolnl fao s — <br />Leaa Appl. Fea Pa10 S� L— _ <br />Belnncv Duo S — — <br />Attach four (4) cop:es of plans for proposed work • Oraw to scale and nole the lol�owing ac applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimension� ol all existing and • Indicate Plorth <br />proposed Slructures on �he �ot • Show any proposed grading changes <br />� Existing and proposed utilities • Show mer:surements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 :i. <br />2. All work shail be performed in accordance with this permit and current Ciry ol Everett Design and Consiruction <br />Star.darils and Specifications. <br />3. Cal� L�cation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•d24 •555. <br />� � F�7�T. /B� <br />Approved for Con uction Date <br />oate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 i.edar Street <br />Everett. WA 98201 <br />Phone: 259•8815 <br />ACKNOV/IEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby 2grees to hold snd save harm- <br />less the City ot Everett Irom any �nd all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance of the impruvement or other right-oi-way use hereto <br />applied for and further agrees to remove same upon notice Irom the <br />City and to replace public property damaged the�eby. <br />�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />