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o8►e S� % SY <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PUEuc Work� Permil • � " / �_� <br />eieo� ono�. • <br />Publw Workt Fee '�0 U 0 <br />Tol�l Fee s _ <br />Le�� Aool Fee PsiE i <br />B�bnceDue E '�1�.cJ_�T,� .�./� <br />L^ -�[,/_J.SJ"'�Ij` <br />qPP���e�� Meiling Address Gily up rnone <br />Project Addresa (il known) <br />Attech }our (4) copies of plens for proposed wo�k - �raw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline ol street <br />• Oulline end dimensiona of all existing and • Indicate North <br />propoaed atructures on ihe lot • Show any proposed grading changes <br />• Exinting end proposed utilities • Show measuremen�s <br />PERMIT CONDITIONS <br />t. All cnlls lor inepection ahall be made 24 hrs. in advance - phone 259•8815. <br />2. All work ehall be perlormed In accordance with this permit and current City ol Evere�t Design and Construction <br />SlanderEs enC Specificetfons. <br />3. Cell Loeation UnCerground Se�vice 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />'� � H )�- .� ( � <br />�IOSe <br />1����a�+ e�-E�Hd.J ��,_� -w .�����. <br />o'it� C-XC[55 dfwnwn„ W.���+, <br />� <br />���/ _ .S 8' � <br />i Date ' <br />y' �v- �; <br />Approvad es Construded <br />everett PUBLIC WORKS DEPARTM[NT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />1' n�s"t'•..` �.ru <br />J <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cify ol Everet� Irom any and all claims for damage�, costs, <br />expenses, or causes ol action thal may arise because ol installation <br />and maintenance o( ihe improvement or other right�of�way use here�o <br />applied f � and further agrees to re E��same upon notice �iom the <br />City an to place public pro erry d maged Ihereby. <br />� � <br />l� ,,���: �`, . ,'� , Z�.c c.�, �/i <br />Signature of Ap � cant Date <br />WORK AUTH IZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAVS DURATION. <br />