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%':.!.. . . . <br />�ate 7 �2S 91J <br />� �PUBLIC <br />Pr(nt or Type Only <br />L1G� �L`hv1 <br />/, <br />+« <br />� <br />Applicetlon For .�O-, <br />WORKS�ERMIT <br />O <br />a g$ <br />H <br />O � � <br />r, «. «. <br />L 1 qz�- � Ev Et.�(2E c�u <br />Nng Adqr;�s�s��-� �i Ciry <br />— � a � � <br />I <br />Ilna AdArwce <br />PuDllc Worka Parmll e�'� . 92 <br />eiac. o.n�.. _.. <br />PUEIie WorM� Fee <br />Tolel Fee i <br />Less AppL Fee PeiO S_� <br />Belence Due S �.j�— <br />dD2 -322 -yo-Ooo- /3- B3/ <br />k��Y �vcr�T� �Q,�., 3 ��. <br />Z�p Phone <br />"� [ip <br />S� <br />Prolect Address pf known) <br />su <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note the following as applicab�e: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />� Existing and proposed utilities <br />0' <br />• Centerline of street <br />• Indicafe North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cal(s fo� inspactlon shall be made 24 hrs. in advance - phone 259�8810. <br />2. All work shell be pertormed In accordance with this permit an� current City of Everett Design and Conatruction <br />Stendards and Speciflcationa <br />3. Call Locetion Underground Service 48 hrs, belore you dig. TOLL FREE NUMBER 1• <br />800-4245555. <br />�f. Gf/ae,� To B,� f?E,e A.ov.e o v�'�� �c.9.✓ <br />0•9TE� 8-/0-90 . �.ae affac.�a�f coPr, <br />Approved as Const�ucted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWL EDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hald and save harm- <br />less the City of Everett from any and all claims for dameges, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right•of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public p�operty damaged thereby. <br />�� �%= s�90 <br />Signafure of App�nt --� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br />t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPL=TION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAC..E OF WpRK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />