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Date�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typct Only <br />nt <br />Describe Proposed Work <br />P�o�ect Add�ass (if known) <br />� n �'OSTING <br />�Q f�7 d V c <br />ling Addiess <br />nuu�ess <br />i <br />2' I;' ''I�? <br />r„m�� wo�x, re,mn . —'��}-�j — <br />omo oen� . IJ�YC ) <br />Pu4bc WorMs fen <br />Io1el FoP S <br />LwseAppl FeePmU S I� <br />Balance0ue S GQ�� <br />qRL�I �J� l-la 1� <br />Z�P Phone <br />ziP Phone <br />Attach lour (4) coplea of plans for propased work • Draw to scale and note the lollowing as applicable: <br />• Property Linas • Centerline ol streel <br />• Oulline and dimensions of all oxlating and � Indicale North <br />p�oposed slructures on tha lot • Show any proposed greding changes <br />• Exlstinp and p�oposed ulllitles • Sliow maasurements <br />PERMIT CONDITIONS <br />i. AII cells la inspectlon shall be made 24 hrs. in advanr,o - phone 259•881 5. <br />2. All work shall be performed in acco�dance with this permit end current City of tveretl Design end Const�uction <br />Standerds end Specillcetlo�s. <br />�. Cell Location Underground Servica 48 hrs. before you dig. TOLL FREE NUMBER 1•800•�{2O•5555. <br />�9.�y �T�,�� �� o.� �oT �v,« .��QU„�,� <br />�UBc �C [.vo,¢.rs t��.er�.�T f��,o,�nri.9 c. <br />everett PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cedar Slroel <br />Everett, WA 98201 <br />Phone:259�8815 <br />ACKNOWL EDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unders�gned owner/epplir.ant hereby agrees to hold antl save harm• <br />les9 the City of Everell Irom an�� end all claims lor demeges, cosls, <br />expenses, or causes of aclion th.�t may erlse because ol instellation <br />end ma;ntenance ol Ihe imp�ovem�ml or olher nghl•obwny use hereto <br />applied for ond lurther eg�er.s to nmove seme upon notice hom the <br />City nnd to r plac3 public prop qy dnroaged �horoby. <br />�ig � o ol pplicant `/ aO � <br />ate <br />W K AU HOHIZED BY THIS f'EHMIT M,UST BE STARTED WITHIN <br />1B0 DAY3 OF DATE PERMIT IS ISSUED FND THERCAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE C7TV UPCrN ANY STOPPAGE OF WORK ON THIS <br />PRO,IECT OVER 90 DAYS DUHATION. <br />