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Date 1��6/84 a��ni�wo�ksao�,.�n. ��7 �U� _ <br /> Application For ama-oao�.+�/ � Q�— <br /> PUBLIC WORKS PERMIT '�' <br /> PUEiICWodePee /� �� � <br /> Total Fee s�_ <br /> Less ApP�Fee Peia S_r�_ <br /> Balence oue $ /^'�� ���1 <br /> Print or Type Only (, 9D3/ <br /> Community Transit 4204 198th Street Suite 201 Lynnwood, Wa. 98036 771-7650 <br /> Owner Mailing Address Ciry • Zip Pho� ; <br /> •� �'4.�'—�_ <br /> �//ii�� <br /> Applicant Mailin�Address City Zip Phone <br /> Site Work <br /> Qoscribe Proposed Work <br /> . C�v����v�T� T.�i9n,LC'/T :r�6-'J'F o.<��-}Tlv:,) C'�.Ji� <br /> - p -,.._,� ^ W <br /> ProjeCtAddress�ifknown) �� �i v�� V/�� � <br /> Attach four(4)cepies of plans lor proposed work- Draw to scale and note lhe lollowing as applicable: � <br /> • Property Lines • Centedine ol street ♦A' <br /> • Outline 5nd dimensions of all exis�ing and O Indicate Norih V� <br /> proposed structures on iho lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> A PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everet� Design and Construction <br /> Standards and Specifications. <br /> 3. Call Lo:ation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> � �� ��'•��r'� �l�4�1' J�/�� ��� � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm- <br /> � less the City of Everett Irom any and all claims for damages, costs, <br /> � � expenses, or causes of action that may arise be;:ause of installation <br /> � - and maintenance ot the improvement or other right-ol-way use hereto <br /> l/�''� � applied for and turther agrees to remo:e same upon notice from the <br /> Ap en5t�v�on Da e City and lo replace public property damaged thereby. <br /> /l n\ <br /> I -AIIV � c� l�l�� ' � �,.�, <br /> U-r.1 � � a} f..p"��- <br /> FINAL INSPECTION Date - — <br /> Approved as Conslructed ignaWre of Applic nt �a��� <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZ Y THIS f'E'iMIT MUST BE STARTED �":ITHIM1I <br /> � 3200CedarS�reet 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8�15 CANCELLED BY THE CITY UPOh ANY STOPPAG[OF WORK ON THIS <br /> PROJECT OVER 50 DAYS DURATION. <br />