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Dat / 6 � <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Pr(nt or Type Only <br />� <br />,y�� y�� ��- <br />g Address City <br />Deacribe Proposed Work /L/�1.:� �"P S �–`L��%G �i <br />Pro�ect Addrese (if known) <br />w <br />PuClic Wo'k� Permll • � `��� <br />Bi�1p. Uapt. t �� 5 <br />PUEtic Wmat Fee <br />iolel Fee S <br />Lesa Appl Fee PeiE i — <br />Balenca Dua j zo C^�' — <br />�J' yVA <br />���� 3 sr'- g y/a <br />Phone <br />Attech four (4) coaies of piens for proposed work - Draw to sca�e and note the following as applicable: <br />• Proparty Linea • Centerline o( street <br />• Outline end dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Ezisting and proposed utilities � Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inapection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shali be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standertls and Speciticalions <br />3. Call Location Underground Service 48 hra 6etore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�j,l lit/STaGG CO�/G.PET� /�•C�ivEsv.a f/ /i�•Po.�J a�E,H%v0 <br />Cu.eEf Li.r/E, <br />�- j�PivEw,aY DE�.eEss�� �•v Ex�sr..c�c- Cti.c�a syuy <br />/�avE To BE ExrF.✓OFo To Atta�,-,o,q4;� p,e,✓E�✓ay <br />sNcw�/ aN P�or .�r.a�v. <br />`7a�����- //—/5-85 <br />Approved tor C truchon _� Date <br />CO _�(o – O lO <br />�IN:\L INSPECTION <br />Approved as Construcled <br />everett PUBIIC WQRKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•8815 <br />ACI(NOWLEDGEMENT OF CONDITIOIJS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and seve harm- <br />less the City of Everett from any and a�l claims for demeges, costs, <br />expenses, or causes of action thet may arise because of installation <br />and maintenance ot the improvement or other right•of•way use hereto <br />applied lor and lurther agrees to remove same upon notice from the <br />City to repince public property damaged thereby. <br />/ <br />' ur of Ap Date <br />WORK AUTHO ED Y THIS PERMIT MUST BE STARTED WITViIN <br />18U DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS f0 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />