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Date �'� ='?�/ <br />Application For <br />p��LIC WOE�iCS P�RMIT <br />C�rint or 1'ype Only <br />[� <br />n,.,�or <br />ity <br />Pu�i�c H'oiks Pormil � �__� <br />B�Oq Depi. • — <br />Publit Woib Fee '� <br />Tolcl Fae $ � l <br />�oss aoo�. aa� ae��e 5 <br />Balence�ue g <br />�� �� <br />ZiP Phone <br />Describe Proposed Work <br />Project Address (il known) <br />��G <br />Attach four (4) copies of plans lor proposed work - Draw lo scale and note � G�n�iPWine of str'ee��abla <br />• Property Lines � Indicate North <br />• Outline and dimensions of all existing and O Show any proposetl gradinn changes <br />proposed slructures on the lot � �how measureme,us <br />O Existing and proposed uYili�ies __�B <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 2a hra in advance - phone 259-881 5. <br />2. All work shall be pertormed in accordance wilh lhis Permit and cu« ent Ciry of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call LocaCion Underground Service �lII hrs. 6eforr, yoi� d19. TOLL FREE NUMBER 1-800•Q24-555J. <br />FINAL INSt'tl:iivrv <br />Approved as Consiructed <br />everett PUBLIC WOR <br />3200 Cedar Streei <br />Everetl, WA °� �207 <br />Fhone�.259�8815 <br />v_ <br />� <br />Date <br />�J <br />'•: <br />� <br />ACi:NOWLEU3EMENT OF CUNDITIONS <br />undersi�ned owner/applir,anl hereby ayrees lo hold and save wsls, <br />the City ot Everetl irom any and all claims for damages, <br />anses, or causes of action thal may arise because of inslallation <br />maintenance of the improvement or other righ�-ohwa;� ��se hereto <br />lied for and lurther agrees to remove same upon notice irom the <br />� and lo replace public property dama9ed thereby. <br />Date �SignaWre of Applicant v v <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STP.RTED WITHI�i <br />EPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT h1AY BE <br />CANCELLED BY THE CITY UPON F.NY STOPPAGE OF WORK ON THIS <br />PROJECT OVEP 90 DAYS DUR%�TION. <br />