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� <br />�, <br />TYPE OR PRINT ONLY <br />. <br />r" dJS �,c� I /V <br />Owner <br />Applicant <br />Application For .. <br />PUBLIC WORKS� PERMIT <br />PUBLIC WORKS DEPAF�MENT <br />3200 Cedar StreP�t! <br />Everett, WA 98201 2�3-8810 <br />�:- ;� c5 ca -; <br />^ � ��: _� �-� �� <br />� � <br />�► �,� � � °;; � =`����--� �5 f <br />Mailing Address City <br />� ��L � C� .��---, �����`'� <br />� � �:'� ' � 1 VV l,l��� <br />Mailing Addre�s�� � � City <br />. :�o; . <br />Describe Proposed Work � <br />�� ��. ������s <br />PROJ <br />f� �_. � /��,�1-r, � � ��ii y <br />ADDRESS (if known) / <br />/' <br />Date -"� c�' � ! <br />Public Works Permit # � � � �-S �� <br />Building Permit # <br />' �_— <br />Public Works Fee $ � � ". <br />; � �=% •, L�/1�..7cUh �� <br />Zi� Phone <br />�! �320� �-Z� �53, <br />Zip Phone <br />- ..�� i�.��- �1 �_ <br />� s���- 7 G�'� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of street 'Indicate North •Show any proposed grading changes •Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />_� /• � ii� /' S'� �� /' -� � . . �. ' �,. _ <br />`7`O/^ �.r� c �, ;�"`_,�.,C �� C ,� ` ", ; <br />�y'�/� �'c7�j �i,6�i�- C�pr,�.r� 1��S���f>�- <br />� /_�/'Gc%'�� ��^a��r �l��;�S ��� ��vc� -���;� �_- <br />jr � �� ./ <br />a� n�r7� �-�' ��� S: �-�: _ <br />� <br />�-, .��1c-� c,�� C��� ��r✓r�'�+%�._ �s"c,srD•'� �G.�?'<� � �^as��r�S <br />�t .� G� r,� c=��� �� �h, F- �,��i�- �.. ���J �-+�.5' � � %�� C'T��"' � <br />% <br />L' <br />S�vC� ��C�'r1S�CY ���"'�� <br />�� .��-t� �� / 7' � �-t,C1 f"� <br />�� ,� ,�/ .-�� ! � =-'.r,- , . <br />/`^ � l.�.'..'.:.., - <br />� <br />�'�' � t G�., i��; i�l /a �rt�/".f" � 1� <br />%i' � � /� %%/'� _ \ <br />W <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />amag ther <br />� <br />ig - Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREA ER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />