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Date��� <br />Application For <br />PUBLIC WORKS PERI►AIT <br />Print or Type Only <br />Mailing Address <br />Cily Zip <br />�'�'' <br />Publm Woiks PmmM1 x � � — <br />r- � � <br />eiay. Deo�� • <br />Avblic Woiks Fee g <br />Totalfec <br />Lx.s F00� Fee Paid $ � <br />eni,���. n��• 5 �O�— <br />Phone <br />Describe Proposed Work �� } `��-�����- — <br />Prolect Address (if known) < « � ✓H� �� � �--�-7 <br />Attach foUr (4) copies ol plans lor proposed work - Draw to sca!e and note the foGowing as applica6le: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisiing and proposed utilities <br />• Centerline of street <br />• �ndicale Norih <br />• Show any proposed grad;ng changes <br />• Show measurements <br />FERMIT CONDITIONS <br />t. All calls for inspecfion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design end Construction <br />Standards and Specitications. <br />3. Call Locatioo Underground Servir,e 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />/ LU'� [.�"� rl�i S/G7/ 7 <br />Approved for nstruction ate <br />��� � . <br />� � L�� ?- f -f% <br />FINAi.,. SP CTION � Date <br />Approved as Construcled <br />everet[ PUBI.IC WORKS DEPARiMENT <br />� 3200 Cedar Street <br />Everetl, WA 98207 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby aqrees to hold and savE harm- <br />less lhe City ot Everett trom any and all claims fer damages, costs, <br />expenses, or causes of action that may arise because ot installution <br />and maintenance ot the improvement or other righl-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />(.�n /� _____['! l�.C-«�� J T /�/�� <br />SignaWre o Applicanl Date <br />WORK AUTHORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEIJTLY PUNSUED TO COMPLETION. TViIS PERMIT MAY BE <br />CANCELLED 6`.' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />