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Oete�=9 / <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Mailing <br />Descrihe Proposetl Work <br />Address <br />Prolecl Address (il known) `r6 ZS— <br />Zip <br />Attach four (4) copies of plens for proposed work - Draw to scale and note ihe Ioi�owing as applicable: <br />• Property Lines <br />• Outline and dimensions of all ezisting and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />App�ovedlor <br />PuUI¢ Worxe Permit • � �' �� <br />oieo. oeo�� • <br />Punl¢ WoiW Fee <br />Totei Fee : <br />Leea ROp� Poe PaiC S <br />oa�.�ce o�a S �� <br />LOT �S'� <br />• Centerline of street <br />• Indicate North <br />• Show any aroFosed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra in advance • phone 259•88� 5. <br />2. All work shall be perlormed in accordance with t�is permil antl current City oi Everett Design and Construction <br />Stendards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•B00•424•5555. <br />T, /l/EuJ �.eiuEwFJ�/ � io dE .Ti✓S:ACGE'c'7 /�E�2. GiT� <br />l�fSiG.r/ S�i�.✓pA.eOS `S6CTioti 3,.j 7 fJ�D ACnaPOi•�lb <br />T Sr.v.✓o.q,eo �9•✓ 't'.�o7_ <br />Approved as Gonstructetl <br />everett PUBLIC WORKS DEPARTMEP:T <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�B815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owne�/applicant hereby agrees to hold and save harm• <br />�less the Cily of Everett Irom any and all claims for damages, costs, <br />expenses, or causes ol aclion ihat may arise because ol installation <br />7 and maintenance ol the improvement or other righbol-way use herelo <br />apUlied for and lurther agrees lo remove same upon nolicP irom the <br />City and to replace public property damaged ihereby. <br />� � � „ _ f. <br />� <br />ignature ol Applic nt � � / ate <br />WORK AUTHORIZ D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMII IS ISSUF.D AND THEREAFTER IS TO <br />BE DILIGENTLV PUFSUED 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 />