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� <br />� <br />TYPE OR PRINT ONLY <br />ApplicaM <br />App 5%ilion Por <br />PUBLIC WORKS PERMIT <br />PUBLIC WOR� UEPARTMENT <br />3200 Osler S�reet <br />Everelt, WA 9�1 259-8870 <br />_ �� <br />b <br />� � � <br />� <br />� <br />Describe Proposed Work <br />� :p City <br />it� I (n� � 1 <br />Mailing Address <br />PROJECT ADDRESS (if known) �L��� �-'�����— <br />O��e.. — --.`�1/zc��� _ <br />Public Works Permit M _ ��1'./� �� _ <br />Building Permit M _.__. ._._ _ _ .. . —_ __ <br />Pubuc Works Fec 5�C l <br />Zip Phone <br />��i�iZl�� �IIEVu <br />Phone <br />(1o(��tic�2-ED <br />Attach four (4) coples ol plans lor preposed wo�k - Draw to sr.ale und note the lollowing il applicable: <br />•Property Llnes •Outline and dimensiens ol all existlnc� nntl proposed shuctures on Ihe lot •Ezisting end proposed utilities <br />•Centedine ol street •InAicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for intpection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this peimit and current City ot Everett Dosign and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-6555. <br />�, �h pc�� ��c�� ���,d d�,�,��; d�,t� q/,�/q�� <br />� <br />--ur� G�`` �e� <br />e`k � 1� �� (� � ��'�� <br />��SR �or �- <br />�� <br />��G�CCf� ___� rW <br />Ap roved lor Constmctlon ���e <br />W <br />� <br />� <br />Y/ <br />� <br />� <br />� <br />� <br />O <br />/�� <br />�/ / <br />O <br />a <br />ACKNOWL[�GEMENT OF CONDITION� <br />The undersigned ownedapplicaM herehy agrees to hold and save hnrmless <br />ihe City o1 Everett from any nnd all claims for damages. costs, eapenses, or <br />cause5 of aclion ihat may a�ise because ol insinllation and mam�enance of <br />the impmvemen� or other righ4o4way use heieto npplied lor anC fudher agrees <br />�o remove snme upon nollce 6om ihe City and to replace public property <br />damaged the�eby. <br />/� � �---- -�-�96 -. <br />Nignatur of Applic�ant �} Da�e <br />S� �— �,�-...�. .F... . r'�-� 5. <br />WOfiK AUTHORIZ[D BY TIiIS PENMIT MUST BE STARTED WITHIN 180 DAYS OF DATE P[RMIT IS ISSUED AND THC�4iEAFTER IS T0� DILIGENTLV PURSUED TO <br />COMPL[TION. THIS PERfdIT MAY �E CANGELL[� BV THL CITV I IPON ANV STOPPAGE OF WORK ON THIS PflOJECT OVEF 90 OAYS DURATION <br />