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i <br /> , <br /> Date � S B� ' ' Publlc Works Permii r � " <br /> BItlB�Dopt.+ <br /> Application For <br /> PUBLIC WORKS PERMiT PubTotalFeaFee $ o , o � <br /> Less AOP�Fee PaiC S -� --t <br /> Ba�ence Oue $ <br /> ao. o � ' <br /> Print or Type Oniy <br /> � �- MacLeod 17�1 R�cker Everett 98201 259-1206 <br /> Owner MailingAddress City Zip Phor_ <br /> Same As Above <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work New flri vPwa�. Sidewal k and Aonroach <br /> � W <br />� Prolect Address(if known) � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the fcllowing as -.pplicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existin9 and • Indicate Norih <br /> proNosed structures onthelot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT COtJDITIONS <br /> 1. AI�calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance v+ith this permit and current Cily ol Everett Design and Construction <br /> Slandards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � �x���M( CNrb � cr.Pro,�. I QhV �10�CWA.IR VKK\ V�' ` t . �D2W � C� O <br /> V �o r ra.�-o.�a.� � "�ca.rcv"'� L' tc� a.n r i o., J o� <br /> S n�C,,.. d.. ,,t�w..� �.o� v'�O 6 e .•.:.�,. ��..1�oe� �/� <br /> 5� 308' ''Ir <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ugrees lo hoid and save harm- <br /> less ihe City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ot installation <br /> 8^ g_� and mainlenance of ihe improvement or other right•of-way use hereto <br /> applied for and further agrees to remove same upon notice t�om the <br /> A d tor struction Date �ity���.i to replace public property damaged thereby. <br /> 8-�8-83 / � ,/�, .,1�', , l,� G� , , ���' � � <br /> Date i ,, ;. �.� - L. - <br /> A INSPECTION � � <br /> Approved as Constructed /Signalure ot Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT tv1UST BE STARTED WITHIN <br /> evere[t PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I Phone:259-8815 PROJECT OVER 90 DAYS DURATION. � <br />