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rV71- <br />L§;J <br />Del@ ll c/ ."'N <br />Apphratior For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner T Mailing <br />P.bw Won. P." <br />e skis Dept a Ll 7,Gt,k`—,/.-- <br />Pvbin Won. Fee <br />Tpbl Fee <br />Lee, A", Fee Pud <br />9elmce Due � <br />Fes. �r f Mailing Address City Zip Phone <br />_. Ap-�plliicant <br />F• .,. n u �. n/ <br />Describe Proposed Work� <br />Project Address III known) go(a - <ZN01 SL /-- - _- <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the following as applicable. <br />• Property Linea • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />UW 1. All calls for Inspection shell be made 24 his. in advance - phod259.8810 e . <br />' 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />aw Standards and Specifications. <br />3, Call LocatWn Underground Service 48 hrabefore you olg. TOLL FREE NUMBER 1 -800-424-5555. <br />eiiiiii, w <br />W I <br />Approved lot Construction Date <br />FINAL INSPECTION Dele <br />Approved es Constructed <br />0 PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />ff Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />Cl) <br />M <br />0^ <br />d <br />Z <br />0 <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 I ereto <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 Applicant Dnte <br />WORK AUTHORIZED BY THIS PERMIT MUST 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 />It, <br />