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Date �'23-93 <br />�J - I z- z�-�- <br />Application For <br />PUBLIC WORKS PERMIT <br />TO POSTING '° -'� <br />Print or TypE Only <br />PubliC WOrk9 PBrmii � G13%3,T 37 � <br />91Cg. Dept. a 41431 <br />lic Works Fee <br />Total Fea $ <br />Less AppL Fee PaiE $ r <br />Balance Due $ �f I <br />Blank 5 Blank Proper.•ties PO Box 2266 Everett WA 98206 355-4725 <br />Owner � MeUing Atldress City Zip Phone � <br />Owner <br />Applicant Mailing Address <br />DescnbePropose�+"�^•4 new house <br />Project Address (if known) f�=��(°'jy/�,.i/ �1� k'.(J� Lot 41 Beve <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• O�tline and dimensions of all exisling and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicale North <br />• Show any proposed grading chany=s <br />• Show measuremenis <br />Phone <br />PEfiM1T CONDITIONS <br />1. All ca!Is for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shal� be peAormed in accordance with this permit and current City of 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 />C/ <br />ion <br />Approved as ConsVucted <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />— less the City of Everetl from any and all claims for damages, costs, <br />/�� expenses, or causes of action that may arise because of instaliation <br />and maintenance of the improvement or other right-oFway use hereto <br />applied for and further agrees to remove same upon notice from the <br />Date City and to replace public property damac�ed thereby. <br />Date <br />-�/ 3 - y3 <br />PUBLIC WORKS DEPAFiTMENT I RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />��r��� 3200CedarSireet 80 DAYS OF DATE PERMIT IS ISSUED ANG THEREAFTER IS.TO <br />Everett, WA 98201 BE D!LIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY BE <br />Pl�one: 259•8870 CANCELLED BY THE CITY UPON ANY STGFPAGE OF WORK ON THIS <br />, PROJECT OVER 90 DAYS DURATIO!J. <br />