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Date-6- 16-0u <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Mike Permit + /zz T <br />Bldg. Dept + <br />Public Wcrke Fee $ / G'f� <br />Tclal r'ea <br />Less APPI. 'eo Paid $ / <br />B'k'nrc Dua S <br />T4" Colorado Corporation 6625 So 190tn #102 Kent, WA 98032 (206) 872-5522 <br />Owner Mailing Address City Zip Phone <br />SAME <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work 1;-m <br />D" - q4 <br />U/'fo rO A —%,.Ol /ji /i // I ., l �/.97'yt hl, t) r , /f ...1 <br />Project Address (if known) rC.ci e w' ( n-r <br />a' ,J of 3/ �erlLp <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the fo loving as applicatle: <br />• Property Lines • Centerline of street Ob <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phon 59. <br />2. All work shall be performed in accordance with this permit and current I y of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />/�� e % / �l e- <br />19Cl ,s— &Jn' l�✓1%/2 <br />Cj'Clll f/ lCJ -7" <br />vT F// iA ic/ <br />for <br />S�rtacr.�-ds ri./rQ �PGfJi� <br />W <br />U) <br />Im <br />O <br />z <br />O <br />O <br />a <br />10 <br />6z, `7 06/20/86 10:27AM 000AN06076-111111N <br />is Yi DPT.20 $122.00 <br />n e- /// ACKNOWLEDC TOFfMWONS <br />/' /J /�/✓J The undersigned owner/applicant hereby agrees to hold and save harm - <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />�6 and maintenance of the improvement of other right-ot-way use hereto <br />applied for further agrees to remove same upon notice from the <br />Date City and �ceq4ubXp'r*rty dWg ier". ?A. F-r,,, <br />Date <br />Signature or Applic rt— / uate <br />WORK MITHORI D BY THIS PERMIT MUST BE ST, tiiED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />