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C <br />Date�S'.� <br />AppiiCation For <br />PU�LiC WORKS PERMIT <br />Prini or Type Only <br />Address <br />�Y Zip <br />PubimVJoiksPcrmnx "� Q� <br />eiag. oeoi. • <br />Puol¢Worksfee � � — <br />Total Fae S <br />Less Fcpl. Fee Pa10 S — G <br />eai,ococu, 5 "-� �j — <br />'�/7IY <br />Applicant Maihng Address City Zip Phone <br />Descri�e Proposed Work _.2 CAR G/�Kli«_ __,3�';,(o <br />Project Address (if known) :�90/ I FnNA�RU <br />Attach four (41 copies of plans for proposed work - Draw to scale and note lhe following as appiicable: <br />• Prope�ry Lines • Centertine: al street <br />• Oulline and dimensions of all existing and • Indicate North <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existinc� and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspec�ion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall 6e perlormed in accordance with this permi; and current City of Eve�etl Design and Conslruction <br />Standards antl Specifications. <br />3. Gall Location UnAerground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-F300-4::4•5555. <br />-(� u,lje G�t �X�S'r��1� c1�;�.� a�c�(�ro.� � �tiS� <br />� 1 <br />G'cira-`2 1T /.��rw.� r�t � ..{ 0.O�a��(.c..,� c1�ncSfS' <br />v r � /� <br />� ,�...�Pv. c;.�f`0,,. i•. � �..._-#,,.r-� �e �.....dltrs�� <br />�l��-� G� ��9���ow.� <br />�,J�- rl-1�+- �-.,:.�� . <br />everett PUBLIC WORKS CEPARTMENT <br />� 3200 Ced2r Street <br />Everett, VJA 98207 <br />Pnone:259�8815 <br />�p��,,,���- w. ll ���. 1"Z°S�tt/Lt✓ <br />� <br />W <br />r <br />� / <br />� <br />O <br />ACKNOINLEDGEMENT OF CONDIPfONS <br />The undersigned owner/applicant hereby agrees to hcld and sove harm� <br />less the Ciry ol Everett Irom any and all clairns lor damages, cosls. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of�way use hereto <br />applied lor and further agrees to remove same upon notice from ihe <br />City and to replace public properry damaged iherehy. <br />��l�� l% VQil��i'1 ��� -83 <br />natwe ol Applic Dale <br />WURK AUTHORIZED BY THIS PERMIT MUST B[ STARTED WITHIN <br />180 DAYS OF D11TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE LILIGENTLY PUFEUED TO COAIPLETION. THIS PERh11T MAY BE <br />CANCELLED BY THE CIT1' UPON f.NY S70PPAGE OF WORK ON THIS <br />PRO,iECT OVER 90 DAYS DURATION. <br />� <br />F�J <br />