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Date —1 q n <br />Applicdlion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Mailing Address <br />PWks Permit- Ido m�� -- _ <br />ales peer <br />PublK Works Fee <br />Total Fee <br />Less eppl. Fee Paid <br />asbnce Due 10 <br />Phone <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work P "i GarQO Al /J r 4 Q. <br />W <br />Project Address (if known) _ J 3d4- �a 3!� .r` <br />Attach four (4) copies of plans for proposed work - Drew to scale and note the following as applicable: <br />to <br />• Property Lines • Conterline of street <br />/A <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />0 <br />1. All calls for inspection shall be made 24 nrs. in advance - phone 259.8810. <br />sti <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />z <br />I)or xk 31- 88 <br />0 <br />I <br />`miWv <br />0 <br />0 <br />a <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everrit"UP'UC WORK1 r,EPARTMENT <br />/i U dder8',r Evarefrerr, NA 94 0 <br />1 <br />Phone: 2S9-F d 10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everwlt from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-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 />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION, <br />