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� . ' � � � ►' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />—f ]:d_!_1_Lr <br />Applicant Mailing qdyrass <br />Describe Proposed Work <br />Project Address �if known) S�OB — J�/�C/!O S PL <br />Zip <br />Attach lour (4) copies of plans for proposed work • Draw to scale antl note the foilowing as applica6le: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed ulilities <br />Puphc WorAs Per � • � O' �J <br />� <br />Biap. Dept. e �'�_ <br />PuUI¢ Works fee <br />Tolal Fae s <br />Less AOPI Fee faia S��_ <br />esia��a o�, S 20 � <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposetl �rading changes <br />� Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All cells for inspection shell be made 24 hrs. in advance - phone 259•8810. <br />2. All work shell be peAormed in accordance wilh this permit and current City of Everett Design and Construction <br />Standerds and Specificatians. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00•424•5555. <br />�f��1-°�` �cro�- a/3/R <br />Approved lor Co r� Date <br />.._ /el �/—�� <br />FI AL I SPECTIOlv Date <br />Approved as Conslructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Eveietl, WA 98201 <br />Phone:259-8810 <br />ACKNOWLCDGEM1IENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned oH•ner/applicanl hereby agrees to hold and save harm- <br />less ihe City ol Everetl from any and all claims lor damages, costs. <br />expenses. or causes ol action that may arise because of installation <br />and maintenance of Ihe improvement or other iighl-obway use hereto <br />�ed for and further ag�lo remuve same upon notice trom Ihe <br />�t and to replace public �o rty damayed thereby. <br />WO AUTFIORIZED BY THIS PERMIT MUS7 BE STARYED WITHIN <br />DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br />CANCELLED BV THE CITY UPON ANY' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />