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Date 9 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Petian • ` / / <br />Bldq. Dept.. <br />Public Works Fee <br />Total Fee $ <br />less Anal. Fee Paid $ <br />Balance Duo $ <br />r)01) - 20LQA/_5 dIa� mA�Is�� 9I/caerT '7 0703 3J'2-/9ga <br />Owner Mailing Address Cd/ Zip Phone <br />s�mc <br />Applicant Mailing Address City Zip <br />GµAlrl LINK F�AiGE <br />nt <br />Describe Proposed Work INSTALI. 4c2 d _(3 —(o - fjLl%NCB L.K/S TiNG PQ(J PL-/L Tr L/NHS _ <br />ewCPT- F02 iRST 006)/1YNX OhCtI6 PE2/nirnnu /-5 sr27:,&F r17 1+A/ILOS15 <br />r tp -tn AAJ annrrnlvrz�b Q n1= 211:.:= O/._ t,yq.✓ /1�0"u -YSTFFG.9CnAv- r� <br />Project Address lit known) ;2 a mad &*1 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• 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 anJ1 proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed 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 />Approved for Construction ate <br />INAL IN PECT10N Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />Ever tt,WACedaStreet <br />Everett, WA 99201 <br />Phone: 259.8810 <br />f13/31/89 8.44AH 000AH5090 <br />#00017614 <br />DPT.20 $20.00 <br />CHECK $20.00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ELU <br />O <br />The undersigned owner/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 cau,is of action that may arise becE ise of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />)R-..-siv— �1� 3-3/-1 <br />Signatur�of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND T-HEREAFTER 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 />