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Date 3 � �} �G <br />Application For <br />PUBL�C WORKS PERM�T <br />Print or Type Only <br />�� /�G+.t ��, � <br />Owner <br />Describe Proposed Work <br />Project Address (if known) <br />ig <br />� <br />Zip <br />2ip <br />Atlach four �4) copies of pians tor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and tlimensions of all existing anC <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />Pu4i¢ Works Parmpppit ���� �_��/'� <br />❑IaB. Oopt. a ��(,L�_ <br />Puol¢ works Fae �/ ^y/ V� <br />infel Fea s <br />Le}s Appl FfB �BiE s <br />Balarca0ue S ���� <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />Il Show measuremen�s <br />1. All calls lor inspection shell be made 24 hrs. in advance - phone 259•881 5. <br />2 All work sha�l be performed in accordance with this permit and curren� City of Everell Design and Conslruction <br />Standartls end Specifications. <br />3. Call Location Unde�ground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�. P.,.,- a�,����,� ��,�� �-�� -�� <br />e <br />����` dpr'PP�I�� J <br />��I� e.;' S� �`�� <br />S� o�^ �_r� <br />l 05�3�y /�l <br />� 4r <br />Approved as Cons�ructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259•8815 <br />7a I ' 7��� <br />ACKNOWLEDGEMENT OF CONDITIOIJS <br />W <br />H <br />� <br />Z� <br />� <br />Oi <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City ol Everett Irom any and all claims for damages, cosis, <br />ezpenses. or causes ol actlon that may arise because ol installation <br />and maintenance ot Ihe improvement or other right�ol-waV use hereto <br />applied for and lurther agrees to remove same upon notice irom the <br />City and to replace puhlic property damaged theraby. <br />�--�, �}� 5 /Z�/ a l� <br />Signature o pplicant � Date <br />WORr( AUTHORIZED BY THIS PERMIT MUST BE S1�ARTED WITHIN <br />180 L`4YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DI�IGENTLY PURSUED TO C044PLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />