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Data�! � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Apphcant Mailing qddress <br />Describe Proposed Work <br />Prc,act Address lif knownl <br />S <br />Ctly <br />City <br />Atfach fow (4) copies of plans for proposed work - Draw lo scale and note Ihe lollowing as applicable; <br />• Property Lines <br />• Outline and tlimenaions of all existing and <br />proposed struCtures on Ihe lot <br />• Ex�sting and proposed utilities <br />PunncwaFSPer ��—/�� <br />BI�B Dept + �_��� <br />I <br />vW I¢ wmMs fce <br />Toial Fec S <br />Less ApPI. Per Pa�U S y <br />ezianceo�e S_�J/10�_ <br />• Centeiline of street <br />• Indicate North <br />• Show any proposed grading change5 <br />• Show measuremenis <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 2S9•8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards end Specifications. <br />3. Call Locetion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-�24•5555. <br />f� ��ma� ��-��a��:,,� �-/�e�..�.� �z6--c� .�,��,a��� <br />t�f�i u :t"�Ccvr,� .a.�.�l�Sc�ae� cc�E'' �7'`��.d�i.1�J <br />�_.�,.�. �✓` <br />�`3p S A,✓D ''d`3o 6 , �L y <br />s � �' ��'� �-� � �6� �.s7��2��-�,� .; 3. 7 <br />V`IIC <br />pproved as Consiructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everelt, WA 9g201 <br />Phone: 259�8810 <br />ACKNOWLEDGEIv1ENT OF CONDITIONS <br />� <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicanl hereby agrers to hold and save harm� <br />less Ihe City ol Everetl from any and all claims for damages, costs. <br />ezpenses, or causes ol action that may arise because ot inslailat�on <br />and mainlenance ol the improvemenl or other righbol•way use hereto <br />applied �or and lurther a�rees to remove same upon notice Irom the <br />City and to replace public p(rp�eµ{� ldamaged thereby. <br />-U.����/�```��X�-S/ CtJ C� <br />m <br />WOf;K AUTHORIZED BY THIS PERMIT P"UST BE STARTED WITH�N <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />6E DILIG[NTLY PURSU�D TO COMPLETION. TIi1S PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE Of' WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />