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Date ��26/93 <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />L ? / <br />PUEI¢ �YorFs Perm�,t • <br />eiaa. oem � -- <br />PuUI¢ Yfar45 Fee <br />TOITI FEP `§ — <br />Lest Pppl Fee Peia 5 / Q <br />Balance0ue S 7� <br />onz - jz z s�� i���.� i <br />North Crest Dev Corp 16212 BoClicll idy SE F129 �fill Creek 98012 <br />ner Maihng �ddress Gty Zip <br />Rick Klem same as aUove <br />Mailing <br />338-1486 <br />.n�a <br />City Zip Phone <br />Descrihe Proposed Wurk Access permit for access to lot 19 Plat of Hollowdale Ct <br />Project Address (i1 knownl <br />�tl�ch four 141 copies ot plans for p�oposed work - Dr2w to scale and note me tollowing as applicabie: <br />• Property Lines <br />• Outline and dimensions of all exishng �ntl <br />proposetl sirucWies on Ihe lot <br />• Eaistir,p ,ind proposed u�ililies <br />• Centerline of street <br />• Indicate North <br />• Show any proposed graAing changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in 2dvance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Consiruction <br />Standards and Specilications. <br />3. Call Location Underc�round Service a8 hrs. before you di9. TOLL FREE NUMBER 1•800•424-5555. <br />jl:����- � 7 �' <br />Apprrn��� o�1Con'I uGion �te <br />l�c�v<= /, '/� ���1f��3 <br />FWAL INSPECTIOM � � <br />�;�proved as Cons�r�cletl <br />PUBLIC WORKS DEPARTMENT <br />��3200 Cetlar Street <br />Everett WA 98201 <br />Phonc'25&8810 <br />ACKNON'LEDG[h1ENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />d <br />The undersigned owneNaopllcan� hereby agrees to hold and save harm- <br />less the Gity ol Everett Irom any and all claims for damages. costs. <br />expenses. or causes of action that may anse because olinstallation <br />and maintenance ol Ihe improvemenl or othcr righPol�way use hereto <br />applietl lor and lunher agree5 lo remove same upon notice irom the <br />City and to replace pubhc property damaged thereby. <br />� ��' ��� G/lr �9 3 <br />Signature o� AppliCant �Tte <br />WORK AUTtiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERM1IIT IS ISSUED AND THEREAF:ER IS TO <br />BE DILIGENTLY PURSUED TO CUMPLETION. THIS PER' 1!T MAY BE <br />CANCELLED B1' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />