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� � \_ <br />Jate �a� 5 ��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� b�.k.�� <br />Zip <br />.J�G-u' <br />Puol¢ works i'ermit • <br />oioe DePI � S L$ 3 8 <br />Puelic worxe Foe S — <br />TotalFeo _. __ <br />Leas AOPI Fae Px�C S <br />Ba�unce Oue S 2p � <br />,�s�a <br />hone <br />Sq v�-1 <br />Applicant Mailing Address City Zip Phone <br />Describn Proposed Work <br />Project Address lif known) ���% �'7 �� �r C <br />A�d <br />Attach lour (4) copies of plans lor proposed work - Oraw lo scale and not� the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing dnd <br />proposed structures on thr, lot <br />• Existing and propoaed utilities <br />PERMIT CONDITIONS <br />• Cente�line ol street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <br />t. All calls for inspection shall te made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be per�ormed in accordance wi�h this permit antl current City of Everet� Desinn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•r100•424•5555. <br />�i�. ,d.PidE's ..'d y .`.�?c:�sr �'E fis/i/ct i F.Cc•�/+7 i s�F <br />E"Oc E oF� Ex.s: �•vc; S.—��EE: • l'e d,.✓c� 7p c:Ty <br />/�iGNT O � <br />- F_ ���y �;,��: <br />S C"cNS�;c=c��:; L�.er/cJELc /�T 7HE. N.E'. Cn,�"nlEi:- L'f <br />/ liis OCT� <br />�.c'C/�E�'iy �i ,�. .f�4�/7/-tiIGTE.�- :'[vt/Off <br />/ <br />FitO/�7 AS/'HdLiEU v-�,�-�-���y <br />� � �� s - o.� �`�,vy��f-w.ey <br />l�ECi�EO 3� Tis�E' t/� ! <br />„ _%/ i�f'f���•en/T iS �F"�c�i.�FU S�cN A <br />!%�T�'i!T f�!< E i�iv7". <br />/ --/ �-c� �_ <br />Date <br />r (� �J � � o <br />�--!� � �1-- <br />\ Date <br />Appmved as Construcled v \ <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259•8815 <br />is T�� BE <br />LC[Af Lmi'.Cc'�'c�,E�f,'% <br />ACKNOWLEDGEMENT OF CO��DITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everelt Irom any and all claims for damages, costs, <br />e�penses, or causes of action that may arise beCaUse of insl011alion <br />and m;intenance ol the improvement or other right�o'-way use hereto <br />applied lor and further agrees lo remove same upon noticc Irom the <br />Cily and to repleCe public property damaged ihereby. <br />_--, <br />. � <br />,� . . � � ,/L , / <br />�i'7% ..���1_/�''!� � � .'��-b <br />Signatu/e ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PENMIT IS ISSUED AND THEREAFTER IS TO <br />BE 0'! IGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCeLLED HY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />