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Date / 9-S 7 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit . ✓ ;?28 <br />Bldg Dept.. 17_0?._ <br />Public Works Fee S <br />Tolel Fee <br />Less Appl fee Pall $ <br />Balance Due s, <br />9LGEi i�eoA9�/E -/9 SE, E✓Eec^,7Ch91 23✓7 %820i' 3S3 -gS <br />Owner r Mailing Address City T Zip Phone <br />BEHcc119'IS C,94IS7-re. 221/- Lk Sre'ENS 9B?:96 32V-o9sSZ <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />D,t'.gin/9rrE S'f/Sr�in i <br />Project Address (it known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <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 />1. All calls 1, : inspection shall be made 24 firs, 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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE N:IMBER 1.800.424.5555. <br />®u/l Fb,c' f39iE"e- IV6- L r/ GaOX <br />�� Pie ri.✓G Lor 70 BF comma c 6rF� &/ JuivE AL" IY97 <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />CO <br />Go <br />O <br />M) <br />0� <br />O <br />a <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 />City and to replace public property damaged thereby. <br />io <br />S�ture of %pplicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAPS 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 />