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Dnte_/12 i MEM <br />M W � [ <br />Application For C L C 1 C 1983 <br />PUBLIC WORKS PERMIT ....... ... <br />CITY OF EVERETT <br />Print or Type Only <br />/S <br />Address <br />(!1/UC--X <br />NuY.ic Works Dept. <br />Public Woms Permit a <br />Bldg Dept.. r,j/!�S7� <br />7Publk Worxe Fee 6 >0.. fl C <br />To1N Fes <br />Less !Poll F» Paid i <br />eetaMe Due i 7-0' <br />Describe Proposed Work IA%S'A« fir lG��hC Cd�✓(!'EiZ'-k'/yl--!U/+\( - <br />Project Address (if known) 101 5. W . Cor 3� i � <br />Attach four (4) copies of plans for proposed work - Drew to scale and note the following as applicable: <br />• Property Lines • Centerlira of street <br />• Outline and dimensions of all existing and • in icate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for Inspection shell be made 24 hr . In advance - phone 259.8815. <br />2. All weik shell be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />pproved o Co ru .Ion Dete <br />_..... .., .,.-..... Date <br />Approved as Constructed L \ <br />overall PUBLIC WORKSKS D <br />Ever Ce Jar Street <br />V Everett, 6 rA 88201 <br />Phone: 251-8816 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W` <br />Y <br />Ch <br />an <br />0 <br />a <br />f� <br />r/ <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 Lecause of Installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further roes to remove same upon notice from the <br />C.rygpd$leplace pubyproperty damaged thereby. <br />K>, RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />80 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 />