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NPE OR PRINT ONLY <br />.) <br />ApPlicationFor i'�' /� / _� � <br />PUBLIC WORKS PERMIT ' Date - <br />PUBLIC WOFKS DEPARTMENT � Public Works Pertnit k T 3 �O <br />3200 Cedar Stmet �'.IJ <br />Everotl, WA 98201 259-8810 � guilding Pertnit N <br />;; � <br />Public Works Fee $ �� �' <br />\f u �.� �� - $1'� <br />� . <br />6707 ,Ua.krl�.��D�,�vt�.�t`E�'' �' crf.�?r,3 �4/�.$' 3s�3-GiS': <br />Mailing Address CNy . Zip Phone <br />Describe Proposed Work C.aw „ c.to �_� <br />PROJECT ADDRESS (if known) <br />. c� <br />Attach four (4) copies ot plans for proposed work - Draw tn scale and note the following N applicable: <br />•Property lines 'Outline and diniensions ot ail existing and proposed struct�res on the lot •Existing and proposed utilities <br />'Centerline of street •Indicate North 5how any proposed grading changes •Show meazurements <br />S3-L� 93 <br />PERMIT CONDITIONS: <br />1. All calis for inspection shall be made 24 hours in advance - phone 259-8610. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Undergroun� Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />/� /�i0 G�ear�nf -�0 1�e a�0�. t,u�7�li�r, y�7��' <br />OT 7�x. S�/'�q ry� . OTNEk <br />iOTAL <br />S 1h5�� GrQ�,�e or /^e� �'OhSTi�u��iah � <br />TenG/^hJ` 47 .S77ILk,.i 9G/T¢Y' LJC�Yi� ST4/��nf <br />C (¢a rir�Jc , <br />�. 1nS�L� 4n e�"OS/Oh �phT�^O QS <br />C <br />�� fhe p �Cic GvotiEs o/¢Pf'. <br />7 �//iS fiPJ"Mr/ � TO/" C�¢4r/nS Oh�/ <br />or Gru.�.�,s �s fo ./Se o�one- <br />q'iredeo� <br />�a Gra ��.;5 <br />Gi-iEi: <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hdd and save hartnless <br />tha Cfly of Everett (rom any and all claims tor damages, cwts, e�cpenses, w <br />causes ot action that may arise because ot Installatbn and maintenance of <br />Me improvement or other right-of-way use hereto applied for and tu,�ther agrees <br />to remove same upon notice from the City and :o replece public pmperty <br />damaged thereby. <br />3�-����� � <br />Slgna�re of Applicant pate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIhIIN 180 DAYS OF' DATE PERMR I� ISSUED AND THEREAFfER IS TO BE DIL16ENiLY PURSUED TO <br />COMPLETION. THIS PERMIT MqY BE CANCELLED BY THE CITY UPON ANY STGPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />