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� <br />L_ <br />Dat�'.zF %3 <br />Appiication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�_ <br />Mailing <br />�l.l� li� <br />� � <br />p.: i_�;..�- <br />1 <br />Pu011c Warks Permll e �/ � �� <br />amc. oen+. e <br />PuElic �Yorks Fee a �'�/l !J � <br />Tolal Fee O v <br />Less AppL Fee Psid S - <br />BelenceDue S�' � �� <br />Sa.,. t'�- — <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />U J� � � b� �P !� <br />F' {�'' C C� E ` t r r c'� c= �r �C Z�? ' . <br />� � <br />Pro�ect Address pt known) <br />Attach four (4) copies af plans lor proposed work - Draw to scale and note the following as applicable: <br />• Properly Lines • Centerline of streel <br />• Oulline and dimensions of all existing and • Indicale North <br />proposed structures on the lot � Show any proposed grading changes <br />• Existing end proposed utililies • Show +neesurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra in advanca • phone 259�8815. <br />2. All work shall be performed In accordence with this permit and current City of Everett Design and Conslruclion <br />Stenderds and Specificationa <br />3. Call Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1-800'424'S555. <br />��Rve w.p..✓� —'�O �K Coc'�o�� GL 5 wo..l� fv��H+�� <br />• p�rG.l��� c� V-tr¢ l�o ci�w�,� ��;. '�.nt w.�-Q. <br />W�- G-�T��S'7'�V.� �� �ccs�.ny o� Sc���n.....: <br />1 �:. C. . <br />S. ,Q�,,P/� 6�t �S � <br />, <br />GA �� � <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everott. WA 98201 <br />Phone:259•BB15 <br />,�, s��' P��,., <br />. , J. <br />�'"�iy, e �'o.� <br />�RvPi..�q„$�; <br />The undersigned owner/epplicant hereby agrees to hold and save herm- <br />less lhe City of Everett trom eny and ell claims tor damagea costa <br />expenses, or causes of action Ihat may arise because of installetlon <br />and n�aintenance of the improvement or other right•ot•way use hereto <br />applied for and further agrees lo remove same upon notice irom the <br />City and)o7aplece public property damaged thereby. <br />i <br />� c%4(' %� 1 /% /U 2 7- S j <br />�zu�f�' <br />Sfgnature of Applicant � Dete <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTER IS TA <br />BE DILIGENTLY PURSUED 70 COMPLETION. THIS PEfiM1T MAY'" �� <br />CANCELLED BY THE CIlY UPON ANY STOPPAGE OF WORK ON' :-.IS <br />PROJECT OVER 90 DAYS DURATION. <br />�^� V`-' <br />4� ��a/� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />_i <br />� <br />J <br />