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Datel1)_3_ft3 <br />APIACatlon For <br />PliBLIC WORKS PERMIT <br />Print or Type Only <br />Pubuc Norkk Perm" a _.-9,. �- ✓� u77 <br />aid, PUPL a _ <br />Publk work. foo <br />Toler Fee <br />Lan APot Fee Pew III _ _^ <br />eslence Dw S <br />Mailinn Address _ <br />City Zip Phone <br />Describe Proposed Work <br />Protect Address (If known) 1a�.J�.� /V <br />Attach four (4) copies of plans for proposed work -Draw to scale and note Ih following as applicable::, <br />• Property Linea •Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures the lot • Show any proposed grading changes <br />• Existing end proposedd utilities • Show measurements M <br />DO N01" WRITE BELOW THIS LINE W <br />PERMIT CONDITIONS O <br />I. All calls for Inspection shall be made 24 hr& in advance - phone 259.8815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specification& <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />%iPf'c iGe v7 /yiusr Cat 4:� Fo.0 Z <br />/qWhQ S DE qqpee SEA ie­ti• <br />/.cJSPrc/icvsl C�Efoe6 G:avE<ivr�SEcc/E�' �cvn f���c{ `ra/ <br />Tc duito�,r✓G, PRoFr-�Y �..,�t L <br />�. TE`s(�1.1G of trtJt eo+aE2 f5 t2rcq'h . rriAA <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damages, costs. <br />� / expenses, or causes of action that may arise because of installation <br />Construction <br />f and maintenance of the Improvement or other right-ol-way use hereto <br />1pproved for Constru ion e`e applied for and further agrees to remove same upon notice from the <br />City and to replace public pro damaged thereby. <br />i <br />'INAL IN N Date <br />pproved as Constructed Sig a I o Appllcan <br />rX Date <br />everell PUBLIC WORKS DEPARTMENT WO AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER IS TO <br />Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY BE <br />Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />