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Datc_X �?/_ -4,-'.5 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Tyne Only <br />a/ <br />Owner Meiling <br />Public Works Permit e <br />Bldd. Door e <br />PubllG Works Fee 9 ?s0 r G <br />Total Fee <br />Lees spot Fee Paid 8 BalanceDue /JCL~ a �� <br />Phone <br />Describe Proposed Work <br />Project Addresslif known) <br />Attach four (4) copies of plans for proposed work - Drew to scale and note the following as al: plicable: <br />• Properly Liles • Centeone of afreet <br />• Oullin� and dimens ..ns of all existing and • Indicate North <br />proposed structureF.,n the lot • Show any proposed grading changes <br />• Existing and propose! utilities • Show measurements <br />Q <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hr& in advance - phone 259.881 5. <br />2. All work shall be performed in accordance wllh this permit and current City of Everett Design and Conctruction <br />Standards and Specifications <br />3 Cnll Location Underground Service 48 hire, before you dig. TOLL FREE NUMBER 1 .800.424.5555. <br />1 1 '! <br />e.r ai±-! telq.. does .e� sew. � t5ce< w�'kk� <br />'�,,;al.,s`,.. <br />t 1pa Is.�. Vo o eel " AQ <br />V-: swat Ik 14�, fit ; <br />:1]1- f"Ar- pe....N <br />%% <br />10%Kj I <br />I CICti + -D <br />w1Wi 10e_ <br />t VslJ/ <br />4 s <br />Sral, <br />PG— <br />Si'+1� <br />elo, <br />/1 <br />+ 3* <br />Date <br />moved as Constructed <br />rvnrr.ry PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />i <br />H <br />(n <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/appliasnt h� -eby ap•ues to hold end save harm- <br />less the City of Everett from on, .,-. I all clams for damages, costs, <br />expenses, or causes of action that tray ease 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 />Signat�f pplicantpplicant Date <br />WOR THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />18o ��YS 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 />