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Date��z6/93 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />auei�cwerFSPermn• __(_L_1J1�`� / <br />Bmn bem. • / _. <br />Pubi¢WorksFee a <br />Tolal Fec <br />Ll'S5 AOpI FCP Pdip S <br />BalanreDue � �C UJ <br />GD?- �7Z5�o//83/ <br />North Crest Dev 16212 Bothell Way SE '�P129 �1�11 CrPek 98012 338-1486 <br />Owner Maihng Addre55 Gty 7_ip Phone <br />Rick Klem Same as above <br />Applicant Mailinq Address City Zip Phonc <br />Descrihe Proposed Work Access permit for access to lot 17 Plat of Hollowdale Court <br />Project Address pf knownl <br />1623 <br />Ntach lour (41 copies of pians for proposed work � Dr�w to scale and notr me following as 2Ppiicable: <br />• Property Lmes <br />• Outline and dimensions ol all ex�st�ng and <br />proposed structures on the lot <br />• Enisling and p�oposed utilities <br />• Centerline of sireet <br />• Indicate No�Ih <br />• Show any propOsed yradiny chan�e5 <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be peAormed in accordance with this permit and currenl City of Everett Des�gn and Construction <br />Standards and Specilications. <br />3. Call Lotation Underground Servir,e AB hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/ z � % �.�' <br />--���� � <br />nppiov � oi,�.�struct�on � Date <br />� /i � <br />%� ;�� �� � /�; �7 <br />FN FN� EC �, �/'� ��Date <br />Approved as Constructed <br />�/`_ / PUBUC WORKS DEPARTMENT <br />�3200 Cedar Street <br />E-vcrett. WA 98201 <br />Phon�:259�8810 <br />W <br />H <br />� <br />� <br />� <br />� <br />a <br />�CKNOWLEDGEPAENT OF CONDITIONS � Z <br />The undersigned wvner/applicant hereby agree5 to hold and save harm� <br />less �he Gty of Everett irom any and all daims tor damages. cosls. <br />expenses. or causes ot action that may arise because of installation <br />and main�enance ol Ihe improvert'�en� or other right-of�way use hereto <br />appiieA lor and lurther agrees to remove same upon notice irom the <br />Cdy and to replace pu6hc property damaged ihereby. <br />� �� ,�� ����9 � <br />Sic�nature ol ApphCant Date <br />WORK AUTHORIZED BY THIS PERtvtl7 MUST BE STARTED WITNIN <br />�80 DAYS OF DATE PERAIIT IS ISSUED AND THER �TER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS Ptr7MIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF VlORK ON THIS <br />PROJECT OVER 90 DAYS DURATtON. <br />