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TYPE OR PRINT ONLY <br />Owner <br />Application Fa <br />PUBLIC WORKS PERMIT <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everen, WA 98201 259•8810 <br />Mailing Addre:s <br />Mailing <br />%i <br />Date �v � �� � � V <br />Public Nbrks PertnM M ��13 <br />Buiiding Pertnit M <br />a0 <br />Public Nbrks Fee S ��� <br />City 7ap Phaie <br />�/Ov � ki �ic�anc�y Wi4 48'033 '4'ZS-$27-770 <br />Gty Zip Phone � <br />� � i � ... . .._ .. _ <br />Attach four (4) copies cf plans for proposed work - Draw to scale and note the tollowing N applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structuros on the lot •Existing and proposed utilities <br />•Centerline oi street •Indicate North 5how any proposed grading chanqes 5how measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in adt�snce - phone 259-8810. <br />2. Ail work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />I i �/'a ci`G COn'fr'b� g�,aL� D� L�One P¢r firy <br />5��•, a/a•-a/ # 7o/A ot '�71�/ B�c oPy Q�a c/it.%, <br />5. `����iCdh7' �SLiaL[ rtP�QCC 4nS/ <br />/ / < <br />�Y`O� C�//'/ns �iS O�CrQTIDh . <br />S�la/�y �� <br />T /' a c"C��G <br />b� do.�e du���� <br />hov�� . <br />� <br />// / <br />`' ����z'9� <br />\ i/(a: — -- � <br />fMAL INSPECTION r Date <br />Approved as Constmcled <br />Sic%c./a L�' <br />o �{— <br />ACKNOWLEDOEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby egrees to hold and save hartnless <br />the City of Everett from any and all claims for damages, costs, ezpenses, or <br />causes of action ihat may arise because oi installation and maintenance of <br />the improvement or other right-ol-way use herelo applied for and funher agiees <br />to remove same upon ootice from the Ciry and to replece public prop�ty <br />dama ed thereby. <br />q.,�./' •�-� ��i i [O�i�{-40 <br />nature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIIHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS DUR4TION. <br />