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Date� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or T�pe Only <br />Pu01ic Work� Pper/m`lt • `" p� _ � � <br />Bltlp. �eoL �O N /� `s / � <br />PUOIIc Worke Fee <br />Totel Fee s <br />Lasa A00� Fae PeIA S_ <br />BalencaDua f �a� <br />„ _ ,. .,. <br />/'vric Sun��Ai I�UC/LTC� 3 ¢ 7 /067 <br />Owner MaiNng Address City Zip Phone <br />�.,r R 7:�� ,�v..�oz �z� G'o�,�o�-��L6 9&'�Z9 678a466 <br />Applicant Mailing Address —� City Zip Phone <br />Describe Propnsed Work /:�CLv �G3/Os7.7%iAL -�v � _ <br />Project Address pf known) �Sc7� %- .C�OVE.e ST. L�'> �34 - E��� E�.a u <br />Attech four (4) copies of plens for proposed work - Draw to scale and note lhe following as applicable: <br />• PropeAy Lines • Centerlir�e of street <br />• Outline and dimensions of all existing and � Indicate North <br />praposed structures on tha lot � Show any proposed grading changes <br />• Existing end proposed utilities • Show measurements <br />PERMIT CUNDITIONS <br />1. All calls for inspection shAll be made 24 hrs. in advance - phone 259•887 5. <br />2. All work shall be porlormed in accordance witli this permit and current City ol 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 />y�, �X� STiN�r ��i[if. CeJt� l L�U,QE3 CUT 7//.6T LcJiGL it/OT <br />�E USEO /S 70 .c'�E T.tE.✓ ovr LyriO .�Eca.,ls>.e�.—Et� <br />�,2 C:>y ST'a•�Di.eD "` .�aS �' �'.3c6lr�i;"s� 6ti�c //E.�-i/�' <br />�U.ef.3 .Q�tXJ �rGi7Fi�'. <br />/I/E"uJ l��P/vEl✓a./ CU.c'6' CV7' 70 BC Lo.c�ST.Pt/CTr_•-D PE.2 <br />/ <br />C� y s.-e.vt�n,co'�S'o7 <br />��i��Gi�2"� /�`rvc�s— ,� �'•�'-AG <br />Approved f Construction Date <br />������%��i K. <br />INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other r+ght•ol•way use hereto <br />applied lor and further agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />� � <br />Sign re of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MU BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE OILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />