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Date d'du MD NIP T E O <br />Appii:ation For <br />PUBLIC WORKS PERIDf071983 <br />. ............ <br />Print or Type Only CITY OF EVERETTPut% Works DOM. <br />e.J-.)fddtta.ill r OnO/ O <br />Melling Address <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />City Zip <br />S <br />Attach four 14) copies of plans for pt6 osed work - Draw to scale and note the following as applicabic <br />Publ, Works Permul : ace i° <br />Bldg Derr • v� <br />Public Work, Fee �� O f] <br />Tolsl Fee $ <br />Less .kppl. Fee PtlE Z< <br />Balance Due $�7. O <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />`161,RX <br />Phone <br />Phone <br />1. All calls for Inspection shall be made 24 hrs. 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 Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5555. <br />led 'e3— <br />j4ppovvid for Construction Date <br />000, <br />FINAL INSPECTION rDate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, 1, WA 982018201 <br />Phone: 259.881 :) <br />ACKNOWLEDGEMENT OF CONDITIONS <br />I� <br />i/ <br />M <br />0 <br />z <br />0 <br />N <br />0 <br />an <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 becsuse 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 o replace public property damaged thereby pp <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIST 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 DURATION. <br />