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everFlt PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett., WA 98201 <br />Phone:: 59.8810 <br />DeteR"IHIM <br />11 Application 6L" <br />ni <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r_ <br />0 <br />VA N DPIoij (3 QaxM � <br />t Mailing Address <br />Describe Proposed Work <br />Project Address lit known) <br />Attach lour (4) copies of plans for proposed work - Drell <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed struclures on the lot <br />• Existing and proposed utilities <br />Public Wm1F Permit I — v <br />Bldg Devi <br />Public Wawa Fee S <br />Total Fee <br />Lew APP[ Fee Pod $ <br />aelea:@n.e 8 <br />b �s6 Sct o <br />U609rr goya 3s6 56�0 <br />:try Zip Phone <br />D <br />q ° ()ObT I 1)WC-T UNOt-R bit <br />AA=irX,X 0 ai NUIiii O Cd <br />IJrr 1 b Jwr <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 him In advance - phone 259-8810. <br />2. All work shalt 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 />9r7x. ct.-f <br />,tlore-: c,(r Y�T/TGf.co ircof .2cn�•u ttia� c�" ti cil 120o e wliie, - <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 />and maintenance of the improvement or other right-of•way use hereto <br />applied for and funher agrees to remove same upon notice from the <br />City and to glace public property damaged thereby. <br />Signature f A licant Dale <br />WORK A H IZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS DF 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 />W <br />I� <br />C r <br />Im <br />0 <br />Z <br />O <br />Cn <br />O <br />a <br />