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Date (1 C <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proposed Work —A) pA-) v U <br />Project Address (If known) <br />Puene Woda Palm <br />Bldg Door <br />Puolld Works Fee <br />Total Fee • -- <br />Lees xPPL Fee Paid 3 . <br />Balance Due i <br />Zip Phone <br />Zip Phone <br />Attach four (4) copies of plans for proposed work • Oraw to scale and note the following as applicable: <br />• Property Lines <br />• Conterline of street <br />• Oulline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the it <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra in advance - phone 259.881 5. <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and Con .;on <br />Standards and Specifications. <br />3, Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />7. /f To ,57^y <br />CLK'B CW G!i?EC. TiYNT ds .04"n *&69 �G%Pi�lb Co.LSIpPUCTiCN/, <br />SioEriAcxri Cc+ee d Gu17r'e Ile, 4&w 'Vew 4 u vDgmyG�O. <br />.s' �feol =Top vc Gw j;.00vrs Tv ee eta Lwe-ey o To 1,94-2-wt tsv <br />rSJ/sTrFin. <br />X-P <br />,n --� Dale <br />pproved as Constructed V <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />0 <br />z <br />0 <br />U) <br />0 <br />a <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 />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees to remove samn upon notice from the <br />City.. aa/nd to replace public property damaged thereby, / <br />Signature of Applicant I I -- <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 C J4ATION. <br />