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oaa��/—�� <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City ' ' Zip <br />�-��.�c—� � <br />Malling Address <br />Pubpt Wod� Permit • v � • <br />tl��p DaD�- • <br />hnuc WorY� faa s dp V p <br />Tol�l Fee <br />Lets ADO� Fea P��C S <br />B�I�nca Due { � <br />Deecribe Proposed Work �cT�K3 /�! �r � `-s�/� '�1C � F/f�/��� J/ /�!'� � <br />� <br />P�o�ecl Addreea pl known) <br />Altach ;our (4) copies ol plens for proposed work • Orew lo ecale and nole the lollowing ea epplicable: " <br />• Property Llnes • Centeiline ol street <br />• Outline end dimenelona ol ell exlsting nnd • Indicata North <br />proposed atiuctures on i he lot • Show any proposcd giading changes <br />• EKlsting end proposed ulilltiva • Show measuremenls <br />PERMIT CONDITIONS <br />Phona <br />All cells lor Inspection ahell he mede 24 hra In advanca ��hone 259•8815. <br />All work ehell be F'�ormetl In accordence wlth Ihis permit and cun ent City ol Evaret; Design end Conatructlon <br />Stenderda end Speclficatlons. <br />Call Locetlon Underpround Sorvice 48 hrs. belare you dig. TOLL FREE NUi`iBER 1•B00•424•5555. <br />Da�e <br />Approved ae Construcled � <br />everett PUBLIC WORKS 0 <br />� 3200 Cede• Slreo� <br />Everet�, WA 98201 <br />1'hane: 259-887 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />i <br />The under:�igned ownei/applicant heroby agrees ta hold and save harM� <br />less the City ol Eve.rlt from eny and ell cleims lo� demages, cosl& <br />expenses, or ceuses af aclion ihel mey arise bacause ol installetlon <br />and meintenence ol �he improvemen� or other �iphbof-way use herelo <br />applied for end further egraes to remove sama upon notice �rom the <br />Cily end to replace public property demaBed thereby. <br />� <br />( • � �� �_ �� r"7 - iJ -.�] <br />Signature of Appllcan� Dete <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DAfE PERMIT IS ISSUED ANU THEREAFTER IS TO <br />BE DILIGENTLY f'Ui7SUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />