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Date ` � <br />�/ <br />Application For <br />PUBLIC 1!1/ORKS i��RMIT <br />Print or Type Only <br />�AG% L�YITT <br />Owner <br />Describe Proposed Work <br />Project Address (if known) <br />��v �EE�.� S� �vP,-,o� <br />Mailing Address <br />Mailing Address <br />���r up <br />�G/� i�i�r .-c Ei �S�/ % <br />G/iJ � � h4�Jti � �/'.�Q�-,� <br />L c- I'�'P-�- <br />� <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot � <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />Public WorMs Permit x �`=� "- ✓' %"' <br />eia9. ocp�. , <br />Public Warks Fee <br />Totul Feo $ <br />less AppL Foe Paid S �J <br />Balance Due $ C � �� <br />%SS'8% <br />-r'i�Zd3 .�53-/I3k <br />Phone <br />3S's- S�s � <br />Phone <br />• Centerline of street <br />• Indicate North <br />O Show any proposed grading changes <br />• Show measurements <br />1. All calls (or inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be pertormed in accordance with this permil and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�Z4:� /� c��� � -� ��.�' <br />Approved for C nstruction Date <br />��—� t <br />INA�!�.-�� :� � � � z �r <br />CTION Date <br />Approved as Constructed <br />everett PUBLIC WORKF, DEPARTMENT <br />3200 Cedar Streel <br />Everetl. WA 98201 <br />Phone:259-8915 <br />� <br />ACKNOINLEDGEMENT OF CONDITION3 <br />n <br />' J <br />The undec �,gned 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 thal may arise because of installa�ion <br />and mainlenance of ihe improvement or other ric�ht-of-way use hereto <br />applied for and iwther agrees to remove same upon notice from the <br />City and to replace public p�operty damaged ihereby. <br />" l�� •� 3/� %�� <br />0 <br />Siynature ol�pplicant . Date <br />WORK AUTHORIZEn BY THIS PERMIT MUST BE STARTED !'�ITHIN <br />180 DAYS OF DATE PERAIIT IS ISSU�D AND THEFEAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMPLETION.'�HIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATICiJ. <br />..� <br />� <br />r. <br />Y <br />t <br />� <br />