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Date ��`7� <br />App�icatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type C•i�ly <br />Describe Proposed <br />�: VEY2.��TT i <br />Project Address (if known) <br />IIoUo �,qKe i.°tr <br />Mailing Address <br />/ts !}aovC � <br />Mailing Address <br />i .�..� <br />n�,�a. £ /I:w.� <br />tn� <br />Attach four (4) coples of plans for proposed work • Draw to ;cale and noto the following as applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Exist(ng and proposed utilities <br />Public Warks Fermit +t __��C�� <br />eme� oao�. + <br />Pu711c Works Fee � � <br />Toiel Fee S <br />La39 AOP� Fen Paitl S�_ <br />Belence Oua S <br />• Centerline o( street <br />� indicate North <br />• Show any proposed grading ch�nges <br />• Show measurements <br />7 <br />Phone <br />E� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Const�uctien <br />Standards end Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE MUMBER 1•$00•424�5555.. <br />� /OC/E �"---'/"'J� /��„'" "�l �j� <br />FINAL M84'ECTION �' / \ <br />Approved as Con�t�ucted �� <br />everett PUBLiC VJCRKS IJEPARTM <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:269-8815 <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />W <br />H <br />� <br />�J <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to ho�d and save harm- <br />less the City of Ever=tt from any and all cla(ms for damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance of lhe improvement or other righhohway use hereto <br />aoP ��r and further agrees t remove same upon notice from the <br />y an to replac puhl' prope y damaged thereby. <br />C <br />,�l -� � �-Zs83 <br />Signature of Applicant � �/b�; Fp� ({�A +'t° � 5S. Date <br />WORiC AUTHORIZED B'f THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS nF �ATE FERM�T IS ISSUED AND THEREAFTER IS TO <br />DE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br />PAOJECT OVER 90 DAYS DURATION. <br />