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Date� V� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO PQSTING. 3 � 9� <br />City <br />Publ�c Wo�ks P=rmi� a �i�C-�����'�+` V—/ <br />amo- oeo�� , <Z -" I <br />Pubhc Works Fee $ <br />Totnl Fee <br />Less An01. Fea PaW $ <br />e�i,��� o�� S <br />Phone <br />AOP iCant Mailing Address L��Y up rnone <br />Project Address (if knownl <br />Attach fow (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ol sireet <br />• Ou�line and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />L <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed 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 />/�, P ��a,��e��O�air.S cla-�� z-7-89 <br />� � � <br />/a 5 � I a� <br />� ___ <br />/ ��� n� � ti— S��—y/ .� <br />0(��se <br />0 <br />Approved as <br />everet[ <br />e <br />��� <br />// Date <br />/ ./ .�/ �Z�d/�/ <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 99201 <br />Phone:259-8810 <br />W <br />H <br />� <br />� <br />• <br />03/17/89 9:35RM OOOAN4867 #MiM <br />/ � <br />H00017458 <br />DPT.20 Sc^39.79 O <br />PW PC S7^c.21 <br />PWIN�P 4451.31 /� <br />MPePU6 SB.00 li <br />H00021368 <br />ELD� 5779.5D <br />B SRCH �3.50 <br />ACKNOWLED�E�pT OF�I�TIONS <br />The undersigned owner/appli��t� agreI.aes lo hold and save ha�m- <br />less the City ol Everett Iro �����73U:`�� (or dama9es, costs. <br />expenses, or causes ot acti �, arise cause ol installation <br />and mainlenance ot the imp other right-ol-way use herelo <br />apnlied tor and luriher agre��fiRemoveSs�Oo@Uipon notice iwm the <br />City ancylo replac�I�cg�pij7qam��gy3hgr�by. <br />54795.^c0 <br />�JORK AUTHORIZE�D BYJ�HIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF` �A�TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PORSUED TO COMPLETION. THIS PERMIT MAY' <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOF7K CY � <br />PROJECT OVER 90 DAYS DURATION. <br />