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Date� �7 , -. . i ' <br />� � Appllcatlon For <br />. PUBLIC' WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe Proposed Wcrk <br />Prolect Address (if known) <br />i� <br />Mailing <br />Mailing Address <br />Pu01ic Works Permlt � __���!%� <br />BIOp. DepL • <br />PuElieWorbFea `�O �_ <br />Totsl Fee s <br />Leaa AOP� Fae PaiE : <br />BalanceDue S C��� � <br />�EC, 7 z 5�93 . <br />Attach four (4) coples of plans for proposed work • Dra�y to scaie and note lhe following as applicable: <br />• Property Lines • Centerline of street <br />• Oulline and dimensions of all exisling and • Indicate North <br />praposed structures on the lot � • Show any proposed gradin9 changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•881 5. � <br />2. All work shall be performed in eccordance with this permit and current City of Everett Design and Construction <br />Standards end Speciticatlons <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />'� ���/ //ti�.� C G.J�G L �C � � N/i' � G GG�) AS �/�� G'i —� <br />�;Yr ci� �� J.� in.�.;�9�—,c ,<=:�'�rj f�/6��� <br />i�:� � � . <br />r_/J���;�.�� � ui/Gc. �._:T'c cc'7'v���/iiz)��i' ,:,-�J S/i� � <br />/v -, <br />Ii�r-i-i�:^-� �ate <br />/ �7 �.f� ? <br />� <br />� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and seve harm- <br />less the City of Everett from any and all ciaims for damages, costs, <br />expenses, or causes of action ihat may arise because of fnstellation <br />and maintanance of the improvement or other right•of•way use hereto <br />appAed��tor and further agrees to remove sama upon notice from the <br />�ty and to�replacrz public property damaged,tlYereby. <br />pproved as Con9truCtetl \ " � S�goatu[e�or Kppncanc ��� � �� ���� <br />�� WO i�K AUTHORIZED BY THIS PERMIT MUST BE STARTED JJITHIN <br />ev� PUBLIC V7bRKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT.�t1AY BE <br />Everett, WA 98201 CADlCELLED BY THE CITY UPON ANY STOPPAGE GF WORK ON THIS <br />._ . n oa.a - - - -- - - - -._._., <br />