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Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 38201 259-8810 <br />TYPE OR PRINT ONLY <br />Owner Mailing Address <br />tiling Address u"y <br />Describe Proposed Work <br />T.vsr11z c -- <br />Data �/J/•�//%"% <br />Public Works Permit k <br />Building Permit # <br />Public Works Fee 5 $- <br />PROJECT ADDRESS (if known) _ 300— W1 /P701E: G 1-rE0 F'C✓D <br />Phone <br />Attach four (4) copies of plans for propos^d work - Draw to sca'e and note the following if applicab,a: <br />•Property Lines •Outline and dimensions of all existing and proposed structures on the lot •E<isling and proposed utilities <br />•Centerline of street "indicate North •Shaw any proposed gradipp 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 4B hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />e <br />Aop plved fcrr nstr'^' ^n ate <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />7 <br />z <br />0 <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm'ess <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />. WORK COMPLETION. <br />THIS PERMIT MAY BE CANCELLED ED BY CITY IL PON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DOIS DURATION. <br />PURSUED TO <br />