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Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />Date <br />Public Works Permit # ( _ <br />Building Permit # <br />Public Works Fee $ -eo— <br />Owner <br />Mailing Address <br />City <br />Zip <br />Phone <br />I._ �., -, ,,, : <br />>_n1,C ,=i.v <br />-4c=1A=)i r-ri <br />! <br />Describe Proposed ork — <br />.l i�5T./JG c f <br />PROJECT ADDRESS (if known) <br />�,fC•%TIC` T" t?00,C'1)' <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />'Centerline of street •Indicate North "Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�ttttttttt� <br />ca <br />O <br />z <br />O <br />A <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />undersigned owner/applicant hereby agrees to hold and save harmless <br />City of Everett from any and all claims for damages, costs, expenses, or <br />ices of action that may arise because of installation and maintenance of <br />improvement or other right-of-way use hereto applied for and further agrees <br />remove same upon notice from the City and to re(_lace public property <br />naged thereby. <br />Date <br />Inature of Applicant <br />COMPLETION. T H SDPBY THIS PERMIT MUST ERMIT MAY BE CANCELS ED a YTHE CITY IUPON ANY STOPPAGE OF WORK ON THIS PROJIECT OVER 90 DAYS DURATION. <br />Y PURSUED TO <br />