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Date ���v 1 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />0 <br />Mailin� Address <br />Describe Proposed Work �C'7-�'C� _L_1' J I � <br />Project Address �if known� <br />c�ry <br />Ci�y Zip <br />Attach four 14� copies o� plans lor proposr.d work � Draw to scale and nole Ihe tollowing as applicable: <br />• Properfy Lines <br />• Outline and dimensions ol all existing antl <br />proposed slruclures on the lot <br />• Ezisting and ptoposed ulilities <br />Pubi�c WorNs Pe/rtryy��5� /_��� / <br />Se�C f �. �I�- . <br />oi.io o�ci.. (� j 7: _�_ �. _ �. <br />f'u�hc Ylorla ica <br />Tolal Fnc S _ <br />LesxAppl Fn��PaW �' T <br />BalanceDue S ��+��, <br />• Centedine ol street <br />• Indicate North <br />• Show any proposed gradin� changes <br />• Show measurements <br />PERMITCONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advanci�- phone 259•8810. <br />2. All work shall be pedormed in accordance with this pen�it and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Approved as <br />everetl <br />e <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Evardit. WA 98201 <br />Phone:259�0810 <br />ne <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />�" <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />less the City ot Everell Irom any and all claims lor damages. costs, <br />e�penses, or causes of action Ihat may arise because of installation <br />and maintenance of Ihe improvement or other righPol-way use hereto <br />applied for and lurther agrees to remove same upon noti;± irom ihe <br />City and to replace pubhc prnpe�ly damac�ed ihereby. <br />. <br />,r� '!' � �r/ <br />Sign ture � plicanl Date <br />WORK AUl ORIZED BY THIS PERMIT MUST BE STARTED WITHIIJ <br />180 DAYS ��F DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVI?R 90 DAYS DURATION. <br />