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Date � �� �� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ytt}�Mon1 Y` ��-�S <br />Owner <br />t -- �; A <br />Descrihe Proposed <br />�. Projocl Address Qf known) <br />�I^Da �,AKe C�rY lJh <br />Mailing Address <br />f /la /iBauE . <br />Mailinq Address <br />� <br />Ci�y Zip <br />���%%'�} <br />Publit Works Permil ♦ r� — �/0� <br />Bldg. Dept. # / <br />Public WarkS Fea /f�/ � <br />Total Fea $ �� <br />Less ApPL Fee Pald $ <br />i/ / c� <br />Balanco Due $ � t �� <br />��7- <br />Phone <br />G`aAD�tib = �,hn�,efl�e,✓� �xoSio� %/hc�uTrr"i Fo� ��-AcRt <br />.� P��1�/! i,o�r►r�n A�oab CvFv�-r,- n'�l�iw wRr' I <br />— ��7 c� �i�C U C, <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note lhe following as applicable: <br />: • Properry Lines • Centerline of street <br />�, • Outline and dimensions of aIl existing and • Indicate North <br />I proposed structures on the lot • Show any proposed grading changes <br />' • Existing and proposed utilities • Show measurements <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 lhis permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TQLL FREE NUMBER 1•800•424•55�55. <br />� �� <br />, <br />� /OCi` i -r__ /r�iii`j� , '":�r'"i.% �,rl',.z�� � r/.��� <br />- \l <br />/���� /� J'� / � <br />'� r��, <br />� Approved as <br />everett <br />� <br />PUBLIC Wb�iKS C <br />3200 Cedar Stree1 <br />Everett, WA 98201 <br />Phone: 259-8815 <br />- �""J �`� <br />Date <br />/�lL < <br />f Date <br />W' <br />� <br />� <br />� � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett from any and all ,.�,aims for damages, costs, <br />expenses, or causes ot action that may arise because of installation <br />and maintenance o( the improvement or other right-of-way use hereto <br />ap�i€d�r and further agrees to remove same upon notice from the <br />City and to replac� public�pmper y tlemaged thereby. <br />:,� r � <br />� <br />��,�c��c�;�� ���! �a-�,s.c�- �-�-S-J3 <br />Signafureo(Applicant�,Ub�. ('Oti (!/� rvIo E �S.S.Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 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 WORI( ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />