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Date��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />HOOf@SS <br />D6_.ribe Proposed Work (v �� �� <br />Pro{ect Addreas (if known) <br />PuElk N•wM� Per • " � �• <br />fl1lp D�pt • � <br />A�o�w wan. v« <br />Tobi R� s <br />4f1�PPLFf�P�W j �^ <br />PaI�M.e Du� f �0 �/�/ <br />(�301 — Ofo�/ <br />Zip Phone <br />l:iry Gip <br />Atlach four (4) copies ot plens for proposed work • Drew to scele and note Ihe lollowing as appiic..ble: <br />� Property Linea � Centerline cf ste.; <br />• Outline and dimensions of a�l existing and � Indicate North <br />proposed structures on the iot � • Show any proposed grading changes <br />• Exinting end proposed utllities • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for Inspection shall be made 24 hra in advance • phone 259•881 5. <br />2. All work shall be peAormed in accordance with this permit end current City of Everett D?sign and Construction <br />Standerds and Specificetions <br />3. Calt Locetlon Underg�ound Service 4B hrs. before you dig. TOLL FqEE NUMBER 1•800•424-5555. <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evere��. WA 98201 <br />Phona: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applican! hereby agrees to hold end save harm- <br />less the Ciry of Everett trom any and all cleims tor dameges, costa, <br />ezpenses, or causes of action that may erise becauce of installetion <br />and maintenance of Ihe improvement or other right-of-way use hereto <br />applied for and fuAher agrees to remove same upon notice Irom the <br />City and to replace public �roperty dameged thereby. <br />, � �' /�� O <br />/ � "� fl � <br />Si�/ol Applicant Dete <br />WORK AUTHORIZED BY THIS PERMIT �NUST BE S�fARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUfiSUED TO COMPLETi7N. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />