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t-3 W <br />ttlj'' � F1 <br />x <br />HrA <br />O H � <br />��yyHH <br />pNH <br />O t7(A <br />H f/j <br />I.3 O fn <br />Date.[.)-n 1sq <br />Application For <br />PUBLIC WORKS PERMIT <br />f(T. ? — <br />Print or Type Only i0 POSTING A(p <br />City <br />L'escril•e Proposed Work <br />MA)12.� <br />.7f� <br />Pup1a WdrM per <br />_ <br />91dp peril.. —' <br />Pum. Wm*a Fee S _-- <br />tolel Fee <br />Leta Appl Fee Paid <br />Balance Me <br />anz-3zz- yo-aoo-i/-8�i <br />as�anR vv��ll'-l�{ <br />exi <br />W <br />_ F.. <br />Project Address lit known) <br />Attach four 14) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines a Centerline of street <br />• Outline and dimensions of all existing and • Indicate North* Show any proposed grading changes <br />proposed structures on the lot • Show measurements M <br />• Existing and proposed utilities W <br />DO NOT WRITE BELOW THIS LINE O <br />rV �\t PERMIT CONDITIONS advance •phone 359.8810Itt1 <br />1. All calls for inspection shall be made 24 hire. in . <br />111 I 2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />t Standards and Speclficaticns. <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.555 <br />cSiTe, CJo eat Tv BF AWW r'E.z PZL9 f�PJ�iZo O <br />Ay XrX ely f�r/Ba/L "&V'Cs' 17,�PT. O.d p$/ 2J lq� �DORfM7B61�,i'tl <br />�111111vv Wee, <br />r� <br />Millet �1 $ 600025798 <br />A <br />t ORVW'! $35.00 <br />CHECK $15.00 O <br />I_ '� <br />L01, <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 A Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <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 r lace ubli oparty m ad thereby. <br />TJ <br />are <br />Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED ''WITHIN <br />1B0 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 />