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Det <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City <br />Describe Proposed Work IrlmxL�9 ie.LnyC^ trL�! r 1 1 tJ art t.el z r ' <br />Project Address (if known) <br />Altanh four 141 coDles of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Publ¢ Work' PRIM • // � _��� <br />Bldg DePt a <br />PublK worn. Fee a <br />Tolat Fee <br />Lau appt he Paid <br />Y 's — <br />aabnc•Dua S�- <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for Inspection shall be made 24 hrs. in advance - phone 259.8815. <br />2. All w.xk 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 hire, before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />G9/23/86 12141PM I <br />VVV / <br />MM81932 <br />DPT.20 $810.00 <br />PW PC $468.00 <br />PWIIISP $2925.00 <br />CH[Clt $4203.00 <br />Approved as Constructed V) <br />everelt PUBLIC WORKS DEPARTMENT <br />Ever Ceder Street — <br />Everett, WA 98201 <br />Phone: 259.8815 <br />0 <br />W <br />H <br />Ch <br />Im <br />0 <br />z <br />0 <br />0 <br />no <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold andaave 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-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 A icant ate <br />WORKAUTHORIZED <br />DPERMIT IS <br />ISEWITHIN <br />ISSUED AND THEREAFTER IS <br />80DAYSOATE TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TINS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />