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Date�% <br />Application For <br />PUBLIC WORKS PERMIT <br />��' Print or Type Only <br />rviawng aatlress <br />Describe Proposed Work <br />Project Address (il known) <br />c��y <br />PubbeWorF�Pnrmlt� ��� �/f�/�.n� � <br />OICG. DeCt �_ �� �� O[ I l�. <br />PuEiic Workn Fee a <br />Tolel Fee <br />leab ApPI Fee PeIA a �0�� <br />B�lance Due s �� <br />Attach tour (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: � <br />• Property Llnas • Centerline of street ' <br />• Outline and dim:nsions ol atl existing and • Indicate North <br />proposed structures on the�lot • Show any proposed grading changes <br />• Existing ard proposed uti�flies • Show measurements <br />Phone <br />0 <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs in advance - phone 259•88� 5. <br />2. All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction <br />.,, Standards and Specilicatlons <br />` « 3. Call Location Underground Service 48 hrs before �ou dig. TOLL FREE NUMBER 1•800�424-5555. <br />q ,irJ�_ tz.'� wwc,�-r- � �,�►-�- s�ms . <br />�-�-L �� F��F+�c— cr� Nor,N� <br />ApprovEd tOr <br />Approved as <br />everett <br />e <br />S . TE fP.�cicA.,i7 �S'flavc0 <br />L�Jyc-'N F,rPos��v� S�oE <br />��,Q T,y/S G U T, <br />PUBLIC OVORKS D <br />3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259-BB 7 5 <br />TA,rE Exr,eA c9.�°f' <br />SE«�E".� Con/�JE� iic n/ <br />W <br />� <br />� <br />Z <br />0 <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrets to hold end save harm- <br />less the City ol Everett irom any .ind all claims for damages, costs. <br />expenses, o� causes of action that may arise becauce of installation <br />and maintenance of the improvemen� or other righFol•way use hereto <br />applied for and luriher agrees to remove same upon notice Irom the <br />City� to replace public proper de aged thareby. <br />- � 'j � � <br />5' �ure i . Date <br />WORK AUT BY PEr:MIT MUST BE STARTED WITHIN <br />180 DAYS DATE PERMIT IS IS'iUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO CUMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO�ECT OVER 90 DAYS DURATION. <br />