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Date 6 5, � <br />Application For <br />PUBLIC W�RKS P�RlVIiT <br />Print or Type Only <br />Applic�nt <br />Mailing Address <br />City <br />Cily <br />Describe Proposed Work .S n�u � rSo.n, t� ��'f� <br />Prolect Address (if known) ��� � � <br />C�' <br />Public Works Perpmi�i x ���/�� <br />BItlO. DepL x JL��/ �� <br />Public Wor4s Fee $ <br />Tolal Fee <br />Less Appl Fee Paid S <br />0alance0ue 5 -�D �r/ <br />�7p a .� <br />Attach four (4) copies ot plans for proposed work - Draw to scale and not� lhr, tollowing a, applicable: <br />• Property Lines • Centerline of sVa:et <br />• Outline and dimensions of afl existing and • Indicate Norlh <br />proposed structures �:�.� �ne lot • Show any proposed �r�ding changes <br />• Existing and proF%sed utilities • Show measurements <br />PERMIT COMDITIONS <br />3s'3- �i � � <br />Phone <br />Phone <br />7. AI; calls for inspeclion shall he made 24 hrs. in advance - phone 2S9-R81 5. <br />2. All work shall be performed in accordance with ihis permit and current City o( Everett Design and Conslruc�ion <br />Standards and Specifications. <br />3. Call Location Undergroun�l Service 48 hrs. betore you dic�. TOLL FREE NUMBER 1•S00•424-E555. <br />� O.EG�Iit//G /��J7'G�✓GG /✓JCiST fiE �C�,�/if/J ¢ iLJOT <br />�vS/lE� /.c�Tl/ �!//.VE - <br />�� /���v��F E",eDS�o�v Co�vTi2oL /f �FCESf�f2y <br />/{/✓L> O/,cFCTcGL� �'!� ��/G�,�/C C�/O,C,�"S ZNSGF�'/O.E' , <br />i <br />Approved lor <br />Approved as Corstructed �-' v <br />everett PUBLIC WORKS DEFARTMENT <br />� 3:00 Cedar Street <br />Evcr=tt, WA 98201 <br />Pho�e:259-8815 <br />ACKNOWLEDGEMENT O!= CONDITIONS <br />W <br />H <br />�/ <br />� <br />� <br />� <br />V / <br />0A <br />1� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />— less �he City of F_veretl from any and all claims for damagec, costs, <br />expenses, or causes of action lhat may arise because of installation <br />�j �S and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees �o remove same upon notice from Ihe <br />ate City and to replace public property damaged ihereby. <br />/ o�- ����`i�--' � /�'/ <br />S� atureo(Applicant ale <br />WORK AUTfiORIZED BY THIS f'EfiMIT MUST BE 3TARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANf7 THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON AIJY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DA1'S UURATION. <br />