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Date_�f�'/� � <br />� Appllcetion For <br />PUBLIC VIiORKS PERMIT <br />Print or Type Only <br />-�s <br />Applicaot <br />Describe Proposed Work <br />l_'oT �� oi <br />r�,s�� H.�-- <br />S� C � <br />S_ � <br />� Pu011c Worke Parmll � ,_ <br />BIEp.0ep1. • <br />Publlt Woda Fae <br />Totel Fao s _ <br />Loen Rppl F Pela S_ <br />Balnnc ue s _ <br />•✓r�i�C ��v �z <br />Zip Phone <br />C�17 <br /><c�T <br />Project Address (il known) � � ��� T .� <br />Atlach four (d) copies ol plans for proposed work • Draw to scale and note the lollowing as applicable: <br />Approved as <br />everett <br />e <br />• Property Lines <br />� Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisling ;nd proposed utilities <br />• Centerline oi streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. Pil calls for inspoction shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specilications <br />3. Call Location Underground Service 48 hrs. belore you Jig. TOLL FREE NUMBER 1•800•424-5555. <br />�/�✓�5 Tfx c� `'�� <br />� <br />PUBLIC WORKS DEPARTMENT <br />3200 CedarSlreet <br />Everett, WA 98201 <br />Phone: 259•88 7 5 <br />�'lT�' S �����• <br />�•S3/� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everett irom any and all ciaims for damages, costs, <br />� ezpenses, auses of action lhat may arise because ot installation <br />�- and maint nahce ol the improvement or other right-of-way use herato <br />' appRed r{td turther agr es ty�remove same upon notice from the <br />Date C.ity an to�eplace public �ogefty damaged fhereby. <br />Date <br />�fgT(�iure ol Applicanl � �' r � � (uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />