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Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />�SE�A- �j,� GP=-f�ll,SS� ?.� <br />Owner Mailing Address <br />y�I,C�61�-- �i� (��` <br />Applicant Mailing Address <br />i <br />Describe Proposed Wark � � <br />PROJECT ADDRESS (if known) <br />� <br />Da�e �! � �� � ' <br />Public Works Permit p ��! ZZZ <br />Building Permit a <br />Public Works Fee $ Z s' <br />� _ E�� <br />Zip Phone <br />cip rnone <br />.� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fotlowing il applicable: <br />'Property Lines •Outline and dimensions of all existing and pmposed structures on ihe lot •Existi�g and p s iliti <br />�$�� �a �:z6AM <br />•Centerline of sireet •Indicate Norih •Show any proposed grading changes •Show measuremenis � <br />-- �--- --....------ ----- —..._ <br />PERMIT CONDITIONS: C�f'iqD G 4� . <br />1. All calis for inspection shall be made 24 hours in advance - phone 259-8810. CHECt; 425.00 <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />L�, INS-t�ll Gr'os�on coh-hal �s dtr�rc�kd by Pvb(� `►ior�s <br />� n S�-Fer, <br />5, �x� s+;r� Z in <br />G� s-Iw�ro� <br />� <br />0 <br />� <br />� <br />� <br />�, ►�ctr,r b�c -Kw� has hcch duwiAgcd bY � <br />Stu��l !� rc ��cd or rc�lx��cd a+ dcVclore,' � <br />Gx�chsG . A�,l ►,� kev► or daw�c�d a�rb �vFF�✓ o+'s �davralK <br />OIA i'�►i5 P'bjCC{'S '�7�1'�A9G S�Ita�� d�50 ���iY6e� orf`C�7�Qtca� <br />a-t' -l�hc d: rr,�+?on o� -l-hc. p� blrc wo�r�s ins���+�: <br />(o.-C1,� das+tna+lon -�rll s;�4c -�-rny ma-Ier�:Al �r►�►ovr.d �Fro� <br />-i�1�,5 5i-Fa. Sha<< hQU� G V��ici PGr`w►�+ -�er /'GGCU%1G'I':'�G MA�CfJt.��, <br />J <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />ihe City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may anse because of installation and maintenance o� <br />theimprovemenlorotherr f-wayuseheretoappliedforandfurtheragmes <br />to remove same upon n tice om the City and to replace public property <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER ISfiO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAl' BE CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />