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Date Z S I <br />Appticatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� , <br />v�oec wo,w. vo,m�n . �— � � _ <br />Bi�a Dep� • ___ <br />PubLc WurM iee <br />iotel Fee S —. <br />le���DV� FeePe�E S <br />B���nceDue S ��%�— <br />n�2-.?22- yo-a oo - ia- a�i <br />Atldf053 <br />Phone <br />Describe Proposed Work ��d �� ���� 1 G� £iilsT�/J�..�{�CVR�/ ��7 � <br />Prolect AAdrese lil knownl �' <br />Attech low (4) copies of plens lor proposed work - Draw to ecale and note Ihe followmg as epPlicable: <br />• Froparty Lfnea • Cenlerline ol street <br />• Outline end Almensions of atl axisting enf • Indicale Norlh <br />proposed structuras on Iha lot • Show eny proposed grading changos <br />• Erlating and proposed ulllitiea • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls lor Inapection ehell be :nade 24 hre. in edvance • phone 259•8810. <br />2. All work shail be pertormed In eccordance with thla permit and current City ol Eve�ett Deslgn and Conslructlon <br />Stenderds end Specificatlone. <br />3. Cetl Locetlon Underground Servlce 48 hre. bolore you dlp. TOLL FREE NUMBER 1-B00•424•5555. <br />T, ��/7y StPCet� �11"G rJ t7i.' �1ZPfi f�e'_n�i q'�' q(� 'f/n��S, <br />5, ..i�i�sf�.11 nh y � ros io„ �on fr�� L�zS di �-,-� t�c� l�y f/��' <br />PuGl�c C�'�rks ��,���E%r . <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedxr Slrael <br />Everett, WA 98201 <br />Phone:258-BB10 <br />02/OS/91 <br />/ <br />q00045655 <br />DPT.20 <br />c�cF; <br />3:13PM OOONN5554 <br />f20.00 <br />s2o.00 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMEN7 OF CONOITIONS <br />The unde�signed owner/applicanl herehy agrees to hold and save herm� <br />less Ihe Cily ol Everetl irom eny and all cleims lor dameges, costs, <br />ezpanses, or causes ol action Ihat may arise because of instellatlon <br />end maintenance ol the improvemenl or o�her righ��ol�way use hereto <br />epplied for and ur [ rfe�� o re / n�J}0 Irom the <br />City and �o re C��f➢p���9��.��C.� <br />/ �� � � <br />�✓i �_� <br />�( analure ol Applicant Date <br />WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMITISISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />