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..� -r-�-� u:;, <br />^� ,�-� � � <br />ate_ <br />Application For - <br />PUBLIC VI/C�F�!(S P�RIVIIT <br />Print or Type Only <br />S{� V�1 <br />Applicant <br />Describe Proposed Work <br />Project ACdress �i( kno�vn) <br />tlSi- 3z�i2v��00uhM. FU! <br />Mailing Address City <br />Alailing Address City <br />Tv�i�i`�/G � /�/.0 L <br />_ �s <br />PUEIic Worke Permlt • <br />emu. oac�. r <br />Public Worka Fee � .A � <br />7ote1 Fee S !� J <br />Leas AOP� Fee PalO S-�_ <br />Balan�e oue S � � J <br />o� z <br />Attach four (4) copies of plans for proposea work • Draw to scale and note the fo�lowing as applicable: <br />• Property Lines • Centerline of slreet <br />• Outline and dimensions of ofl existing and • Indicate North <br />proposed structures on the Ie;t • Show any proposed grading changes <br />� Exisling and proposed utilitie, � • Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made'?4 hrs. in advance • phone 259•881 5. <br />2. All work shall be pertormed in accor.fance with this permit and current City of Everett Design and Constructiun <br />Standarils and Specifications. <br />3. Call �ocation Underground Service 48 hrs. 6efore you dig. TOLL FREE ��MBER 1•800•424-5555. <br />'¢ � r Svlec% �✓il� � � <br />�S. %i�OS%e�2. G//n�'d ( `??.P�Y C���-/ ��5�'�.�tY. <br />/ <br />nppr�• � na as �.ons�ruc�ea <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 9A201 <br />� Phone:259-8815 <br />ACKNO'.VLEDGEMENT OF CONDITIONS <br />The und^rsiynad owner/applicanl hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes ot action that may arice because of installation <br />and maintenance of the improvement or other righbol�way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public preperty dama9ed thereby. <br />Sigtiatur Applicant ' " � ' Date <br />WORK UTHOR�ZED BY THIS PERMIT fv1UST BE STARTED WITHI <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERFAFTER IS T <br />BE DILIGENTLY PURSUED TO COMP�ETION. THIS PERMIT MAYG <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON Tt j <br />PROJECT OVER 00 DAYS DURATION. / <br />