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� -- <br />Date����' d'� <br />� Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� � / Jc <br />Owner <br />B�rf /. �c �r9� <br />Applicant <br />J O �rx /S <br />� 1_ <br />Describe Proposod Work „T �� `�'�r 1L� Oc r� <br />Prolecl Address (if I:nown) � � <br />2 <br />W� <br />Pu� WorMe Permi� • <br />Bi�fQ. Deo � <br />Pi,G4�.. Work = <br />.e,. e <br />l A04� Fae P�iU � <br />B�lence Due S <br />.r.• �i' % �l �G <br />Sz'S s�l <br />Q� 1 S"2 �BPC <br />Pno�a <br />Atlach four (4) copies of plans tor proposed work • Draw to scele and note� CQ^�tadine ol streeii able: <br />• Property L(nes • Ind�cale North <br />• Oulline and dimensions of all ezisting and � Show any Proposed graiiing changes <br />proposed structures on the lot � Show measurements <br />• Existing end proposed utilities � <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shell be peAormed in accordance with lhis permit and current City of Everett Design and Construction <br />StanCerds end Specificetions <br />3. Call Location Underground Service 48 hra belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />,� r�.��,- �x� ��� ��_�. ��1� <br />r �..e.—�� 7-.�.��i ��l" �s r�.✓b . <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98207 <br />Phone: 259-BB15 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />0 <br />�"' <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City ol Everett irom any and all claims for damages. costs, <br />ezpenses, or ca�ses ot aClion that may arise because ol ins+.allallon <br />and mamteoance of the improvement or other righbohway use hereto <br />applied for and further agrees to remove seme upon notice trom the <br />City and to replace oublic property damaged thereby. <br />,/�/.�[j� , � ,�1� - S <br />$� ign:d re ot Appl ant Date <br />WORI< AUTHORIZEO BY THIS PERMIT MUFiT BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLtD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />I PROJECT OVER 90 DAYS DURATION. <br />