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-.-,�. _ .._,� �`- - _ _ , .� �+� <br />, <br />� <br />oate�3G�J G � <br />Applicatlon For <br />PUBLIC WORKS <br />Print or Type Only <br />Applieant <br />� <br />PERMIT <br />Mailing Address <br />R4. -�. ,. <br />� <br />� <br />PuD�ic Workt Perme • / ) <br />BIGG. DeGt � ��u ! � "% <br />PVCiicWorksFee : <br />Tolel Fee <br />Lev AOV� Fee P��E s <br />B�i�nce Due ± <br />City 2ip Phone <br />Gi � .[� 1/�I_ <br />DsacMbe Proposed Work / �% �'(%�L�� � g'y!—LrJ S ry <br />Prp�scl �ddroae (if known) <br />Athch four (4) copiea ol plana lor proposed work - Draw to scale and note the following as applicable: <br />� PropeRy linea • Centerline of street <br />• Outline and dimensiona of all existin8 antl • Indicate North <br />proposed structuroa on the lot • Show any proposed grading c�anges <br />• Existinp and proposed utiliNes • Show measurement� <br />M <br />PERMIT CONDITIOP'S <br />1. All ulla tor Inapectlon ahall be mede 24 nrs in advance • phone 259•8815. <br />2. All work ehall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Stenderds and Speclficetiona <br />3. Call locat�on Underpround Service 48 hra before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />�fib �vBtiL Gr.b,ets <br />� <br />PUlLIC WORKS DEPARTMENT <br />3200 C�r StreN <br />Ewntt, WA 9e207 <br />Pnons: 259-JB16 <br />f�lhiT ,�'�li�,eE,p <br />/ ,3v/8 6 <br />W <br />H <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersipned owner/applicent hereby eprees to hold and tave harm- <br />lesa the Clty of Everett Irom any end all clalme for dam�pe4 cost� - <br />expensea, or cauaea of ection that may erlee becauee of Inatallation <br />and maintanence ol the improvament or other rlpht•of•way use herolo <br />applied (or and further aqreee to remove seme upon notice from Me <br />City and to replace pubNc property dema0ed theroby. <br />Sipnatura ol Applicent Dats <br />WOqK AUTHORI2ED BY THIS PERMIT MU8T BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT �3 ISSu ED AND THEREAFfER IS TO <br />BE DILIOEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPA(iE OF WORK ON TMB �, <br />PROJECT OVER 90 DAVS DURATION. <br />