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.n,; <br />�, .;,.0 �_ ___,. <br />,„�� <br />Date � ��y ��6 <br />Application For <br />PUBLIC VI/ORKS PERMIT <br />Print or Type Only <br />�� <br />�)�v� <br />Mailing Ad <br />Pu01ic Works Permil s ���� <br />BIEB� Depc > <br />Public Worka Fea S <br />Tolel Fea <br />Loss Fppl Fea PeiJ $ /�� nry <br />:� <br />BalanceDua �— <br />� �4' C����s 9�020 �� 2>�z <br />Describe Proposed Work �W L � ���� <br />_ <br />C1�Y G�P r�wii� <br />Prolecl Address (if known) J � � � � � " — <br />nttach lour (4) copies ot i�lans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline o( street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changr.s <br />• Existing and proposed utilities . • Show measurements <br />PEFIMIT CONDITIONS <br />1. AII calls for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shall he performed in accordance with this permit and current City ot Everelt Design and Construction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />TEmPo.t'A�Y <br />�S b'.t%Gin/ <br />� -2� -B�_ <br />�,coS%oi✓ Co.•rlT/20G To 8E Oan/6' <br />o.ri !�s'�.eddE.G �tH�✓S li9TE� <br />Ti/.s ��'se�iT /s fo2 <br />�o ,�,dr J�/STAGL fJ y <br />o.rJ s�C9�✓ <br />C�E'�,e�.✓G �' G.ev�i,�G- o�vt� - <br />oF' DR�liN9�E Sysr�.n -f'f/c,�.J <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />B�erett WA 98201 <br />Phone: 259-8815 <br />W <br />H <br />� <br />� <br />� <br />O <br />Ob/24/(iG 11�27{�i OWRN0673 ��*� <br />ACKNOWLEDGEMEN+f OF CONDITIONS <br />The undersigned owner/appli�by ��hold and save harm� <br />less the Ciry of Everett irom nd al irfi for damages, costs, <br />expenses, or causes of action that may arise 6ecause of installation <br />and maintena�ce of ihe improvement or other right•ol-way use hereto <br />applied for d lurther agre s to remove same upon notice iro�n the <br />City and to�ePlace public p�pe�damaged thereby. <br />n� ture of A plican Date <br />WORK AUTHO Z BY THIS PERMIT MUST 8E S7ARTFD WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGE�TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />