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OH <br />[rJ I- � <br />A�x <br />9 xHsyy(A <br />H 5� <br />�C A <br />H xl <br />FW m g <br />H C <br />ZHE <br />H H <br />C] C7 N <br />M <br />1-3 0 y <br />C r <br />Date -yZ' <br />Application For <br />PUBLIC WORMS PERMIT <br />Print or Type Only <br />��S IL'G(C-hL/C <br />Mailing Addle City <br />Mailirg Address City <br />Pubis Works Perms <br />• <br />B-ap. Dior <br />Public Works Fee <br />T.W Fee <br />S <br />Les. APPI. Fee Pus S <br />Balance Due S J <br />Zip <br />Ir S 5 " <br />Zip Phone <br />CI✓/✓k AA-eCiwG /ieGs1 G 12 jO 4/.1� <br />Describe Proposed Work �2.�Ll� � <br />Project Address (if known) .Z e F � <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable'. <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Cr,s O,g and proposed .,tilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />ution Date <br />AedC <br />—FfNIAL INSPECTION Dele <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />Ever Cedar tree <br />Everett, Cedar <br />98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />CIO`) <br />ca <br />0 <br />a <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-of-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 Applicao L/ Date <br />RMIT MUST BE STARTED <br />180RDAYSTOF DATED BY THIS PERMIT IS ISSUED WITHIN <br />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 />