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Date 9 '�a 5� <br />qppli�ation For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />t,Lll YAN � <br />��� <br />Mai4ing <br />Mailing <br />�J�„:. � 9�-�-5"_ <br />Public Works Parmit + �`� ��� O <br />eme.�ecL. ��5��% <br />Public Waikc Foe <br />Toia� Feo $ <br />Less AOP� Fee Pala 5 <br />Balence Uue $ <br />b��'�Y <br />PS�TAV. Ct_EVE4IND �I9�Ij CZ.16 <br />� <br />Zip <br />� <br />t -�� O O�,v <br />Describe Proposed Work �-��sT • �� � � W OOD � I2AM c _ <br />n'iA I� P 6, I N T `✓' "T b R.C. <br />Project Address pf known) <br />Attach four (4) copies of plans tor proposed work • Draw to scale and note the lollowin� as applicable: <br />• Property Lines • Centerline ot sireet <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading cha�ges <br />• Ezisting and proposed utilities • Show rneasurements <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 pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />ir % B� C'oys%.�'vcrz=o P�i2 AoP.eovF.v Pcu.us' <br />j>Q,�EO /�/2-��S <br />Approved for <br />C <br />Approved as Constructed �/ <br />everet[ PUBLIC WORKS D <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: �':9-8815 <br />Dale <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant hereby a9rees lo hold and save harm- <br />less lhe City of Everetl from any and all claims lor damages, cosls, <br />expenses, or causes of action Ihat may arise because of installation <br />and maintenance of fhe improvement or other right•of-way use hereto <br />applied for and lurlher agrees to remove same upon nolice Irom the <br />Cily and to replace public property damaged lhereby. <br />Signalur�L�' � Dat� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG�NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />i <br />z <br />0 <br />-� <br />c`�'� <br />m <br />�. .. <br />-i � <br />.. —i <br />�n x <br />0 <br />m <br />c o <br />mo <br />�c <br />om <br />-i z <br />x --I <br />m <br />.o z <br />�i <br />... .-� <br />� N <br />s <br />� <br />o� <br />T 3 <br />-i m <br />x <br />rn «-� <br />N <br />O <br />or <br />c� m <br />C N <br />mN <br />z c� <br />�m <br />a <br />� <br />� <br />x <br />a <br />z <br />� <br />x <br />w <br />z <br />0 <br />� <br />� <br />m <br />