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Date�� <br />Applicatlon For <br />PU�LIC WORKS PERMIT <br />Print or Tvpe Only <br />��c.l 3��5�-/7L�GC�. � <br />M�iling Address Ci�y <br />+� �•� <br />�,�� <br />Describe Proposed Work (`'°'<�—u�-^•= ��'°"� <br />f�,�-A�.i,..i.�.u�- �.�,w •�.c,� <br />Prolect Adtlress (d known) <br />Pu01ic Workt Pnrm11 • ✓ —/G� <br />Oiey. Dept • �� �� <br />PuElic Worha Fee s <br />To�el Fae <br />Lew poo� Fee PaIA S <br />Belance Due s ��r � � <br />%�8D'� <br />� 7�t3-� <br />Phone <br />Zip Phone <br />�.,4,4v�" <br />Atte�h lour (4) copies ol plens for proposed work - Draw lo scale and note tiie lollowing as applicable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions of all existing and • Indicate North <br />��roposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremen�s <br />PERMIT CONDITIONS <br />1. A'I calls for inspection skall be made 14 hrs. in advance - phone 259•8815. <br />2. hll work shall be performed in accordance witli this permit and currenl G�ly of Everett Design and Construclion <br />Standerds and Specifications <br />3. Cell Location Underground Service 4B hrs. belure you dig. 70LL FREE NUMBER 1•800•424•5555. <br />��.�" ��,f 5�/'a/8s <br />Approved lor Cor�struction �ate <br />� iv - ir'-�=,— <br />'FINAL I�ION� Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAPTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•88 i .; <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The untlersigned owner/applicant hereby egrees to hold and savr, harm- <br />less tYm Cily of Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other rigM-ol-way use hereto <br />applied ior and turther agrees to remove same upon notice Irom ihe <br />Ci�y and to replace public property damaged ihereby. <br />� <br />Signa�(ire oi Applicant / �ate <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITIiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTLY AURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY l'HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIUN. <br />