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Date��-f Pu�lic Works Perm�, `� � — <br /> BIOp Deo�.• � <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT PubTolelieeFee : <br /> Lees aoC�Fee Paia s��� <br /> BelanceDue = <br /> Print or Type Only 75,� <br /> ,�'�— %�/,',P11 4/FI,�IF,c/ �>/:�� .�.%_/�L �%ni.F'i 1,F�7"Z_ 7`i'%—Srn F� <br /> Owner Ma�ling AAdress City 2ip Phone <br /> z <br /> 0 <br /> -� <br /> Applicant Mailing Address City Zip Phone m <br /> //EL</ CO' .tiS�.Fi � //O.C/ � lJF.�i![t �[JlI_1/C' l •• <br /> Describe Proposed Work ��—" '--' <br /> --� �t <br /> .. -1 <br /> in x <br /> m <br /> W � <br /> cv <br /> m� <br /> Project Address(if knownl 5 L��� ��'�����'`"9`, `C��� � � 3 <br /> m <br /> -� z <br /> Atlech four(4) copies ot plans for proposed work• Draw to scale and note the lollowing as applicable: � _"� <br /> m <br /> • Properry Lines • Centerl�nF ol street p = <br /> • Outline and dimensions of all existing and • Indicate North D � <br /> proposed structures on the lot • Show any pronosed grading changes � _ <br /> • Existing and proposed utililies • Show measuremenis � �N <br /> < <br /> � <br /> DO NUT WRITE 6ELOW THIS LINE O ,O� Ay <br /> PERMIT CONDITIONS '� m <br /> x <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone Z59•881 5. � m N <br /> 2. All work shall be performed in accordance with this permit and curreM Ciry of Everetl Design and Consiruction <br /> Standards and Specilications. �m <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-BOO•424•5555. � 3 N <br /> / m <br /> .�. ��liY G2- /�iwCCL��I���`. O � m <br /> � A <br /> h �' <br /> _ <br /> a <br /> z <br /> � � <br /> x <br /> ., <br /> O N <br /> z <br /> 0 <br /> � ~ <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> - less the City ot Ever:tt irom any and all claims lor damages, costs, <br /> expenses, or causes of action Ihat may arise because of instaltation <br /> �_�d� � and maintenance ol the improvement or other right�ol�way use here�o <br /> �� applied lor and further aorees to remove sama upon notice irom the <br /> Approv d for Construction � Date City anA to replace public property damaged thereby. <br /> �`'ro73-,�f�� �� �¢`�� <br /> AL II E TION Date � <br /> Approved as ConsiructeA Signature ot Apqlicant Oate <br /> WORK AUTHONI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DHYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITI'UPON ANV STOPPAGE OF WORK ON TH�S <br /> Phone: 259-8815 pROJECT OVEfi 90 DAVS DURATION. <br /> II <br />� <br />