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TYPE OR PRINT ONLY <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />T� POSTING auc o 4�ssr <br />—G <br />Owner <br />Mailing <br />Describe Proposed Work <br />/ <br />Date 1 ' Z2i 9 �" <br />Public Works Permit N 76 Z�A <br />Building Permit # <br />Public Works Fee $ J��� <br />fi Ga:d � z v96 <br />9s7�► zs5 �3� <br />� <br />Phone <br />Phone <br />PROJECT ADDRESS (if known) �'"""' ' �- ucv�-. v �-.�-� - <br />Atlach lour (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines •Outline and dimensions of all existing and proposed siructures on the lot •Existing and proposed utilities <br />•Canterline of sireet •Indicate North 'Show any proposed grading changes •Show measurements <br />FERMIT CONDITIONS: <br />1. AII calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. befcre you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�. �Ji",� I�o �G� <br />D� 7-Z 3- y6 <br />(h'+y�4rs 4//�a <br />�ohe ����" �0<<raS �z��pf^oY� <br />� <br />• �v«e.�` �vL�L.�c �t�or�c' <br />� �d <br />� �C°/o3/C Q«4 c�¢ ) Plan dafcCi <br />�j <br />� 25-9b <br />♦i� <br />V♦ <br />O <br />a <br />� � � V �n <br />�� <br />JU� 2 S j996 <br />............................... <br />CITY OF EVERETT <br />BuilCir.� Division <br />AUKrvVwLtwtMtrvi vrl.vrv�nv�w <br />The undersigned ownedapplicani hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for dama�es, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />ihe improvement or other righbof-way use hereto applied for and further agrees <br />to remove same u»n notice from the City and to replace public property <br />thereby. <br />� 1 � l •�-3 •�i � <br />ignatu of plicant�T� Date <br />J <br />WORK AUTHORIZED BY THIS FERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />