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Date 3 �� <br />Public Works Permit e <br />Application For <br />TO POSTING <br />Bide. Dent <br />PUBLIC <br />WORKS <br />PER�VIIT <br />PubTotal Fee <br />Total Fes $ <br />Less ApeL Fee Feld $ <br />O <br />7z <br />Print or Type Only <br />O C] O O <br />O to t <br />o <br />Balance Due $ <br />G1o7-�y5e?3/zs3 /` �O°J rt1 <br />c cca r4 <br />n c- <br />Oo2 — j�2YO/ln83 / f 62 Sr <br />4?2r�4 �53-797n <br />ovto, <br />�4/7 Eioreo <br />Eriare�% <br />Phone <br />Owner <br />Mailing Address <br />"rn LGlty <br />o,xz-, <br />Zip <br />Phone <br />Describe Proposed Work ha U lN 0r� n o J ,$144(.10__A Aft C ✓eA+0 <br />Protect Address (if known) <br />Attach fOL. I4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • 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 />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />Cr/o,�c To 13� A�N�- fc� Si>� PcA� fiP�,eovc� <br />�y .-Hr _� <br />c.ry P�d'L. G Lt/O��f7 1 /Y S <br />�01py eel C'Az d0 <br />Approved as Constructed <br />WORKS DEPARTMENT <br />6LPUBLIC <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />N <br />z <br />O <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 further agrees to remove same upon notice from the <br />Citvs3lhd to replace Public propqrty damaged thereby. <br />Signature o Applicant Date <br />WORK AUTHORIZED B THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT 15 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 />