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6 <br />r_ <br />Date� ��� <br />Application For <br />PUBLlC WORKS PERIVIIT <br />Print or Type Only <br />I%a 1'e y Protktn p�i7c. <br />� Owner Mailing <br />S A�r E AS �lBovE' <br />Applicant Mailing <br />� <br />sE E <br />i �� <br />Puolic Works Permil a___LG�./I� r � <br />em9. oeot • <br />PublitWorksFce $ J^JG SZS� <br />7otal Fee v <br />Less AppL Fon Paitl � � v� <br />Balance Due � �� <br />�i <br />1 <br />35'3 <br />3s3i' <br />Describe Proposed Work �- �%s /�G� // �%t t C/ /'(CC �S S tc. I GO !' /7 P r` O T'� /�/�O�l'�'/ � <br />,�natc�eh i �a w1 Q��CAA/JiY/S'E/�1EAlTS. <br />Project Address (if known) <br />Attach four (4) copies of plans for propoaed work - Draw to scale and note the following as applicable: <br />w Property Lines • Centerline of street <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 o Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordanca wiih this permit and wrrent City of Everetl Design and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service �8 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />y �.�sT,�.�� �.r2 �.�-T9�� <br />s, ���4;�, c�� � t�� <br />t�`�� ;, � ;.; � <br />, �, � <br />%'�� � /v �e.u� % <br />J <br />., <br />_ a �. <br />pproved as ConsVucted \\ <br />J <br />evemtt PUBLIC WOFKS 0 <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 25�J�8815 <br />Date <br />s�,�.� ' � - . <br />�� � <br />�� l,-� G�.� ��Q <br />. , .�� , ,� <br />��- :► ri�:: ; , <br />W <br />H <br />� <br />� <br />O <br />H <br />u� <br />7IIIICN6WLEDGEMENT OF CONDITIONS <br />The undersigned �wner/applicant 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 of action that may arise because of instailalion <br />apd maintenance ot the improvement or other right•obway use hereto <br />�lied for and further agrees to remove same upon notice from the <br />�}yt�d to replace public property damaged thereby. <br />� �-19-�3 <br />S nature of Applicant � Date <br />WORK AUTHORIZED HIS PEaMIT MUST BE STARTED WI'HIN <br />180 DNYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY 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 />