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Date * 03 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,� Teed Uri 0E,e,dy. �"c-zu ���N WA <br />Address <br />Describe Proposed Work <br />Project Address (if known) <br />rally <br />Pubic WorMs Permit'83 3/ 8 <br />{• 3 <br />Bldg. Dept. • "' <br />Public Worts Fee <br />Total Fee <br />Lou APPL Fee Paid S <br />Balance Due ` M <br />471.75 <br />gszc3 35r6tD% <br />I It in as applicable: <br />Attach lour (4) copies of plans for proposed work • Draw to scale and note the <br />Centerline of street <br />• Property Linea <br />• Outline and d,menalona of all existing and <br />•Indicate North <br />• Show any proposed grading changes <br />propnsed structures on the lot <br />• Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall he made 24 hrs. In advance • phone 259.881 5. <br />2. All work .hell be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specification& <br />3. Cali Location Underground Service 48 hr& before you dig. TOLL FREE NUMBER 1 -800-424-5555. <br />i <br />C. <br />M <br />0 <br />7 <br />O <br />l� <br />Cl) <br />O <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS ' <br />The undersigned owner/applicant hereby agrees to hold anv save harm- <br />less the City of Everett from any and oil claims for damages, costs, <br />expenae& or causes of action that may arise because of installation <br />end maintenance of the In d%other right-of-way use hereto <br />lfiCL �.---/a—'?1-8 appll for and further agrees to remove s b upon notice from the <br />ion Date City to to replace pu//t/]�fIIcc property damh0 hereby. ' <br />rnVHL nvorcvi wn cilgnarura m nyy.^"'•^ <br />Approved asConstructa. I WORK AUTHORIZED BY THIS PERMI MUST BE -STARTED WITHIN <br />everett PUBLIC WO S DEPART EI4'r' 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS T <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8815 PROJECT OVER 90 DAYS DURATIUN. <br />