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y— _ _ <br />� .� . � <br />�e�� , <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,Vp� Owner : Jers �p <br />- .. <br />.: <br />;�:�E.-,�—�.� <br />Publ¢WorkaFea s <br />Tolal Fee <br />Lesa ApO�- Fee PeIE s� <br />Belenca Due s <br />cv�rku�(;�n a�oa-aa�ol St Fve�r�- Q�ao� as�—�3�/ <br />� r�Owner � -� MaiNng Add�ess Gity' Zip Phone <br />Describe Proposed Work <br />Project Fddress (il known) <br />AttaCh four (4) copies of plans tor proposed w�rk - Draw to scale and note ihe followin9 as applicable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensi0ns of all existing antl • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exis�ing and proposed utilities • Show measurenienis <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shell be made 24 hrs. in advance • phone 259-8810. <br />2. All work shell be peAormed in accordence with this permit and current City of Everett Design and Construction <br />Stenderds end Specifications. <br />3. Cell Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� <br />ApGrOv�d as Constr:ir,trd " <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CederStreet <br />Everett, WA 98201 <br />Phone;259-8810 <br />ACKNOWLEUGEMENT OF CONDITIONS <br />� <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owneUapplicant hereby agrees to hold and save harm� <br />less the City ol Evere�t Irom any and all claims for damages, costs, <br />expenses, or causes ol zction that may arise because of installation <br />and maiMenance ot ihe improvement or other righbof�way use herelo <br />applied for and furiher ngrees to remove same upon notice Irom the <br />City and to.replace publ!� property damaged thereby. <br />Siqnature o� Anpiican �' Date <br />WORK AUTHORI7. BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECI O\'EP. 90 DAYS DURAiION. <br />