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TYPE OR PRINT ONLY <br />HAEL <br />Apphcatlon For <br />PUBLIC WORKS PEF�MIT <br />PUBLIC WOF�'S DEPARTMENT <br />320D Cedar Sireet <br />Everett, WA 9820: 259-8610 <br />ZO r/ <br />�� J/i fFr,� <br />Mailing .4ddress <br />jA7, � F <br />Applicar,t Mailing Address <br />� <br />�f ��'�9�0 � <br />Date _ � <br />i <br />Public Works Pertnit # ��/"-�� <br />Building Permit # _ <br />n <br />Public Works Fee S_ o7�J � <br />Bk <br />EYf2E /l 95�1 a�l �� r-_ �. <br />City Zip PF-..9 <br />City Zip Phone <br />Describe Preposed Work F,.-��: fl C ��� /c;iacr D� icN r✓� Gu G�<<� �,�, <br />� <br />�k�A�.,;�,t <br />PROJECTADDRESS(i�knoeon) .�8 i*% �h%>r-ci�y_rQr/G. <br />Attach four (4) ropies of plans for proposed work - Draw to scale and note the followicg if applicable: <br />•Property Une: •Outline and dimensions of all existing and proposed simcture<_ on the lot •Existing and proposed utilities <br />•Centerline c` street •Indicate North •Show any proposed grading chances °Show measurements <br />LINE <br />PERMIT CONDITiONS: <br />1. All call� for inspection shall be made 24 hours in advance - phor�e 259-8810. <br />2. All work shall be performed in accordance with this permit anc current City of Everett Design and <br />Construction Standards and Specifications. <br />�. Call Location Underground Service 48 hrs. before you dig. TC�LL FREE NUMBER 1-800-424-5555. <br />/, .�70��<'�'C 7D CUri�7�.or�3" t'� /iJ/O''-C�li�i L- <br />� n, l/._ C'T ��7Y�v e ri�:. � <br />✓ <br />� � <br />Date <br />Approved as ConsWr.ted <br />04102/9b <br />/ <br />N00096131 <br />OTHFF. <br />CHECI; <br />1:07PM <br />S^c0. � <br />szo. o0 <br />W <br />� <br />s <br />v♦ <br />k:K:Kt <br />ACKNOWLED: EMENT OF CONDITIONS <br />The undersiyned ownedapplicant hereby agrees to hold and save harmless <br />the Ciry o( Everetl lrom any and all claims for damages, cosls, expenses, or <br />causes of action that may arse because of installation and mainlenance of <br />the improvement or other righFof-way use hereto appiied for and luriher agrees <br />b remove same upon notice from iha City and to replace public property <br />damaged ihereby. � <br />1 � <br />� <br />f gignhffirp of Applicanl ,� �� " Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS iSSUED AND THEREAFfER IS TO BE DILIGENTL'; PURSUED TO <br />COMPLEfION. THIS PERMIT MAl' BE CANCELLEL� E3Y THE CITY UPON ANY STOP°AGE OF'NORK ON THIS PROJECT OVER 90 DAYS UURATION. <br />