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n,� a_1�l �� <br />ApG�icafion For <br />PUBL.I�; V!/ORKS PERNIIT <br />Print or Type Only <br />ruelic works Permit p• <br />914�. Depl. � _¢ <br />a�euc wo�ks Fae <br />Tolnl Feo $ <br />Lets N00�� Fee PaiE g <br />Bala�ce Oue $ <br />_.✓ <br />��"N�� � �?'JF.' ��(L��.::�"r.' 1A o2 �FPC'�� S�' !_1i%�P�7T /.f/.9 /"�i'h? 3 , 3 S/7- 5`OA'a— <br />Owner Fdai�inc�A�dress City Zip Phone <br />C'cyvr�r v�v�rr� �/�.. <br />!.lailing Address <br />Zip Phone <br />Desr.r/ib/e Proposed Work it� ,_ti1 T �.� j(rj�(�iyJr �, /�1/�t�GTf:r 6t^-� ��c% . v(%� <br />ry ��L �%�/%�"T 'f—_:.Z i�iRlP�?—T,� . 7% ��o �/%1/./�PD �C'rYJ,p�w7`-i / <br />Project Address (it known) <br />Atlach four (4) copies of plans lor propos=_d work • Draw t� scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisling and proposed utilities � <br />PERMIT CCNDI i IONS <br />• Centerline ot sireet <br />• Indica�e North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All calls for inspection shall L� made 24 hrs. in advance - phone 259-$(i1 5. <br />2. All work shall be perform2d in accordance with this permit and current Cdy of Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. hetore ynu dig. TOLL FREE NUMBEfi 1-800•424-5555. <br />� /=�r �ior�c�t'�,C�,c>v.s' �%�� /Z_-/2--P 6 <br />/ y <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />�! "/ia/� � <br />���f �* �r 458�9 <br />ACKNOWLEDGEMENT OF CONDITIQNS <br />W <br />H <br />� <br />� <br />7 <br />O <br />� <br />� <br />O <br />a <br />The under�igned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City of Everett trom any and all claims for damages, cosls, <br />expenses, or causes of acticn ihat may arise because o! installation <br />and maintenance of lhe improv?ment or other right-obway use hereW <br />applied for and further agrees lo remova same upon notice trom the <br />City and to replace public prraerry damaged ihereby. <br />Si ture of Applicant ' ��� <br />O K AUTHORIZED BY'fH15 PERMIT NiUST BE STARTED WITHIiV <br />DAYS OF DATE PERMIT IS ISSUED AND THERGAFTER IS TO <br />flE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UFON .4N\' STOPPAGE OF WORK ON THlS <br />PFiOJECT OVER 90 DAYS DURAT!0�4. <br />