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c� Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8610 <br />TYPE 05 PRINT ONLY <br />Owne, Mailing Address <br />Mating <br />iXKCA.✓A <br />city <br />Date&ermit# <br />Public Works_! J1 <br />Building Permit D <br />Public Works Fee $ '•�� <br />Zip <br />wR (r.04) sap 40 <br />Zio Phone <br />Describe Proposed Work C>rxvA JeTiAt4 4 E .rj-0/10 KC60 rIELY rE45ill417"7 <br />LU <br />.S-,rVby Tlfffr G✓/j�L fCG✓TLC !PL/qe/^)¢ E4'uiP/iF.tlT /J THE R/ds/T OF !✓may � !kC H <br />to SGCdL� <br />IP/bNfOilrJ.V� /S .tloT O< RE4JLAL G'SE �F-.tlD wE ALC ��'oPaS/�`I¢ �/' <br />c>c%[ �?UioitLul- As SNp,T.v�£C i rI � <br />PROJECT ADDRESS (if known) nE¢AL 9r ANA uFoL�tigEUELE Tr N ld <br />) <br />Attach tour (4) copies of plans for proposed work - Draw to scab and note the following if applicable: ^Z?GfJ 1 4d QfG1i ]Y/-ti._ O <br />•Property Lines 'Outline and dimensions of a,: existing and proposed structures on the lot •Existing and proposed utilities <br />'Centerline of street •Indicate North •Show any proposed grading changes 'Show measurements <br />0 �` `PEWIT CONDITIONS: <br />Pa"'' <br />;All calls for irsF=t:tion shall be made 24 hours in advance - phone 259-8810. O17401 �ali be performed in accordance with this permit and current City of Everett Design and <br />^tructlen Standards and Specifications. ' <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5j55. low <br />Peri1el /S for 90 clays G�iLy <br />�O/77 4 C4 7h e EvL rc7� P!/�!G Gil/I-FS O <br />%f /� qn PX7GC�>7fatr !1 heCessary an <br />S% Gcclss' Prv6Lz�r�-�.�s' _,,lcr.rl�-�i of�i2r' �oL/rnni/�5 f1 n �j <br />OW/r2i-S /ix13/ i� �S�VY.� OZTo � � V L� D <br />74�i MAY 2 01996 <br />................... ................. <br />CITY OF EVERETT <br />Buildli Division <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages. ,,osts, expenses, or <br />causes of action that may arise becaLse of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and f,.rther agrees <br />to remove same upon notice from the City and to replace pul property <br />damaged thereby. //-- �r <br />1uo01/ Oi/ Corp <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED 4D EREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON -THIS PROJECT OVER 90 DAYS DURATION. <br />