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[r � <br />�� . <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLiC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY <br />Address <br />Describe Proposed Work <br />m <br />PROJECT ADDRESS (if known) _LJ� <br />Date__.�'IL/ /� <br />Public Works Permit N_` 1� f'j—I <br />Building Permit # <br />i <br />Public Works Fee 5 � <br />Cily Zip <br />City Zio <br />Pho�= <br />Attach four (4) copies ot plans for proposed work - Drew to scale and note ihe following if applicable: <br />•Pioperty Lines •Outline and dimensions of all existing and proposed simctures on the lot •Ezisting and proposed utilities <br />•Centerline of sireet •Indicate North •Show any proposed grading changes •Show measurert.ents <br />� <br />NOT <br />LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-f1810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards arid Specifications. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER i-800-424-5555. <br />�, I"I�ilt%^,tM 2 �vl�yi i'�'lu,n o-F 1-�-�. sc%� (�z�Lti� -�yaN► •�-,ce. o� <br />�rDU� •t�J ��tGk � �"1' SiciQ(n����K <br />J <br />Approved as Consiructed <br />� <br />� <br />♦�^ <br />Vl <br />O <br />a <br />OS/19/97 4�O:,F;� ,,,,ORk.i2?? ::.:k:. <br />/ <br />4:00097149 <br />CTNER s^C.O� <br />CRSH i20. L'0 <br />ACKNOWLEDGENFNT UF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />ihe City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />lhe impmvemenl or other righl-of-way use hereto applied for and further ac�rees <br />to remove same upon notice from ihe City and to replace public property <br />damaged thereby. <br />2%� �• c�� .��9/97 <br />Signature fApplicant ��e <br />WORK AUTHORIZED BY THIS PERMI"f MUST BE STARTED WITHIN 1E0 DAY�S OF DATE PERMIT IS ISSUED AND TNEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />