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Date 7'��'�3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Mailing Address <br />Describe Proposed Work <br />Project Address (if known) <br />3`l�y G-!, <br />� sr M�N��r <br />c�cY <br />Public Worke Permll r � /� � <br />eia9. oaPi , <br />PuDTotalFeaFee � �f1 � � <br />v. <br />�ess ApO� Fae Paitl S � /] <br />Balence Oue $ ^ • � � <br />Attach four (4) copies of plans for propased work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline cf street <br />• Oulline and dimensions of all ezisting antl • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />�- ��,�r, <br />Phone � 1e <br />„ M 1 <br />Phone <br />y83-ai�-� -or�F <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and currant City of Everett Design and Construction <br />Stander7s and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�424-5555. <br />'r. ex�5+"i n C c-c[ess � re� �..r t� (u O� <br />J <br />,� ; se,,...0 <br />for <br />GG�TG/�.�o... (�Z!'w..� fP�N./C�cX <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett WA 98201 <br />Phone:259•8815 <br />) � <br />Date � <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIOiJS <br />The undersigned owneUapplicant hereby agrees to hoid and sa��e harm- <br />less the City of Everetl from any and all claims for dameges, costs, <br />expenses, or causes of action that may aAse because of insteilation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove seme upon notice from the <br />City and to replace public property damaged thereby. <br />� <br />Signatur of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS iSSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATI�N. <br />—� <br />