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Date�3"�" <br />Application for <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />th <br />P/P7'I" ���'/ <br />Ci�y 2ip <br />PubLc Wo�Fs Pmmil • /� ���.�� <br />oiae oew. � �! J� <br />Pu�l¢ \VaeAs Fca s <br />Tol�l Feo <br />less AOo� Fce Pa�itl 5 `� <br />palance Oue S � <br />S n�l '�- <br />Applicant Idailing Address Cily Zip Phone <br />Describe Proposed Work <br />Project AtlCress (il known) <br />Atlach four (4) copies ol plans for proposed work - Draw to scale and nole the following as applicable: <br />• Proper�y Lines . <br />• Outline and dimensions of all existing and <br />propased s�ructures on Ihe lot <br />• ExiSiing and propo5ed utililies <br />• Centerline of street <br />• Indicale Norih <br />• Show any proposed grading changes <br />• 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 lhis permit and current City of Everett Desic�n and Construction <br />Standards and Specilications. <br />3. Call Location UnderAround Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-806•424-5555. <br />� ,��u GJ�r/� �o fie o�in-� �c'ta�� Q�l�c� ��� <br />(�tip-,/;� /�'�•zi•'�` c�a.f'cd1 � F-8B <br />J!'" -a�-�T �Go ./%/yc�Cn.c.� � %1r:,c,�L -r�`-� GKCc�G� C�O'.0 <br />�`" = ���6�:.y ��-f �,-� ��'".�t`�' <br />.� ��� <br />,�iC� �,�.;� _�/.�` ,�1� ,fu cu�d � z� .�u«�� <br />Approved as Consiructed <br />evcrett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl. WA 98207 <br />Phone:259�8810 <br />ACKNON'LEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersigned owneUapplicant hereby agrees to hold and save harm- <br />less ihe Clty ol Everelt Irom any and all claims tor damac�es, costs, <br />expenses. or causes ol action Ihat may arise because ol inslallation <br />and maintenance of Ihe improvemenl or o�her right�ol•way use herelo <br />applied lor and furiher agrees to remove same upon notice irom ihe <br />City and to replace puUlic pioperty damaged ihere6y. <br />. <br />� �- �-8� <br />Signa ure o Applicant Date <br />WORK AUTfiORIZED BY THIS PERMI�f MUST BE STARTED WITHIN <br />1B0 DAVS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CANCELLED BY THE CITY UPON A�,Y STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOV. <br />