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Date-44a-3/sq <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Zip <br />Public Mika Pr it • �� _ GO <br />Bldg Dept <br />Pubw Wmka Fee f <br />Total Foe -- <br />Les+ApPL Fee Paid S _ <br />aelanca Due�— <br />AppliceMailing Address City Zip Phone <br />Describe Proposed Work Wl (:(M ( Aa 411141 'U Y&.z2—k-ziS44 <br />Project Address lit known) it Z " rx (E Giii <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 />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. <br />2. All work shall be perfo,med 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 />,.�� •.5/JE/_(i'nG � fiyt ONE%' E;/e.e�-,e���.✓ G�.9y <br />TD BE G> f2�i0E� <br />70 8F oo.acc <br />Approved for Constru tion i Date <br />L <br />FIN Date <br />Ap oved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone. 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />Im <br />0 <br />n <br />Z. <br />0 <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 />;xpenses. 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 />ly and to replace publ c property damaged thereby. <br />Ugnat.re of Applicant Date <br />WORK AUTHORIZED BY HIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PE IT 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 />