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rro <br />y to <br />Date4t/o j� <br />H = <br />y H <br />Application For <br />o o <br />PUBLIC <br />WORKS PERMIT <br />r+p H b <br />y N H <br />tt Z <br />Print or Type Only <br />O H <br />z n c <br />H to O <br />n• n <br />Lid ?f <br />H <br />Owner <br />MayutmgAddress/� <br />SH <br />1.0 <br />�7 t7 N <br />T <br />1 f T i -1-NQ <br />1'V ABC /m' <br />ttl t' <br />oti� <br />fT Applicant <br />mailing Address <br />M <br />O <br />H tyi'. <br />�T <br />Describe Proposed Work e{• <br />.C, '1W yQ <br />Project Address lit known) <br />City <br />City Zip <br />Public Walks Permu e - — -- <br />Bldg peril. • _�')'^�-� - <br />Public Works Foe <br />Total Fee g— ----- <br />Less APpl Fee Paul <br />Beisnre Due $ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />r 1. All calls for inspection shall be made 24 hrs. In advance • phone 259.8810. <br />I �` alias2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />el" �' 3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424.5555. <br />i <br />i <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />W <br />W <br />O <br />Z <br />O <br />W <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 OVER 90 DAYS DURATION. <br />