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.. '_'_-�.'a.�-r�a•T'?-""".cs- ' _ - � . <br /> � - ...\4t.t�. � ..+�ic�'�_ � � . �y.,o ... ... . , ' <br /> . . .. . '.�r��.mao� --`'- r..k <br /> Date� 9� � � Public Worke Permil s _ _ <br /> Applicat(onFo� � emA.oau�.,r 90/2!280 __ <br /> PUBLIC WORKS PERMIT PuciicWurkaFee - - <br /> Tolel Fee S <br /> � Less Appl Fee Pei� S <br /> Baianca Du �' S <br /> Print or Type Only <br /> � , ' — , <br /> ; Ewrgrean lrame c �'ininh 10701 Everqreen 11ay - tA Ewratt <br /> � Owner Mai4ing Address City Zip Phone <br /> Atohitectv r;:�rthweit 18915 - 142nd Ave NE M170 Noodinville 98072 <br /> Applicant Mailing Address City Zip Phone <br /> i <br /> Describe Proposed Work .- 'Mflllnt 7ywY'oVamsnt <br /> 4 _ W <br /> ` Project Addreas(if known) _ 1MN ien.. .�n�v _ �� � � � <br /> Attach lour(4)copies ot plans for proposed work- Draw to scale and note the folloeving as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> propOsed stru�tures on the lot • Show any proposed grac�ng changes �' <br /> � • Existing and proposed utilities � • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE O ; <br /> PERMIT CONDITIONS ; <br /> 1.All cplls tor inspection shall be made 24 hrs.in advance•phone 259-8810. � ; <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction ' � <br /> Standards and Specificationa <br /> ! 3.Call LocaBon Underground Sarvice 48 hrs.before you dig.TOLL FREE NUMBEN 1-800-4245555. �� , <br /> q' / / O . <br /> �(�1�i:C LtJO^✓--- �F/'✓.'�� � /�°�� '�Ct CK,2t.CF' � <br /> , <br /> ' �:��.. �.�.,�%�-:�-..� � <br /> � - �¢ e -90 � x <br /> • � � <br /> aa <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownei!applicant hereby agrees to hold and ssve harm- <br /> less the City of Everett from any and all claims for damages, costs <br /> expenses, or causes of action that may arise because of installation <br /> ar.d maintenance of the improvement or other right-of•way use hereto <br /> Approved tor Construction Date appiied for and turther agrees to remove same upon notice Irom the <br /> City and to replace oublic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date �� <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> E��erett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PER�'IT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 GAYS DURATION. <br />