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Appiication For <br />PUBL"C W4RKS PERMIT <br />Print or Type Only <br />nnauing <br />� <br />Publlc Wods Permil • � �% <br />eiae� oem. • S � ry <br />Puelic works Poa <br />Toial Fee S _ <br />Leaa RpO� fee PeiE S <br />Balance0ue S �� <br />)'fiQozJ� <br />Phone <br />���Y up Fhone <br />Describe Proposed Work NZW C� �'`J �CU °1.T�16X� C5%1.J ,�U(�L� (—jQ��y.�TZy <br />.�W4 � � .�JG <br />Prolect Address (if known) <br />Attech four (4) copies of plans for proposed work - Draw to scale and note the lollowin9 as applicable: <br />• Property Lines • Centedine of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changec <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />7. All cells (or inspection shall be made 24 h�a in advance • phone 259•881 5. <br />2. A�I work shall be pertormed in accordance with ihis permit and currenl City of Everetl Design and Construction <br />Standards end Specifications, <br />3 Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �i(/STdG ' /2 ~ � �O.UG.z'ETE �u�^'T <br />A��,�x � ' <br />S PAc�E i�O�cTin�� C� O/zice<«�q/ /.c� T�rE G'iTf/ <br />�'il-Hr oF t�U.a`/. bv�ry' �'qD��s AS Sf/cc��ti� n,�l Ptbn:'� , <br />�'. �'i�E�JGy �O�'�C <br />Ari�,znr-Ei� J��,�tis <br />y� �E' CON.ii.E'lICTCD /�S /�ci! <br />ve �v C> - zv- �s <br />��>>i /T-d��/�i— G-'—�C�-c`��� <br />Apprrn;�: 11or C� struction Dale <br />� ��� .?-3-�C <br />Date <br />as Construcfed <br />everett l PUBL�C WORKS DEPAR7MENT <br />�, 3200 Cedar Sireet <br />JEverett, WA 98201 <br />Phone: 259•8815 <br />%�!o'Jf <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The undersigned owner; app'icant hereby a9rees lo hold and save har.�n- <br />less ihe City ol Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action ihat may arise because of installation <br />and maintenance ol ihe improvement or other right-ohway use here�o <br />applietl lor and further agrees to remove same upon notice Irom the <br />City anQ.1 repl�ce pul(Its,property damaged Ihereby. <br />i \ <br />/ J <br />/� /rl/� n. � Q- � <br />Signature of Applicant Date <br />WORK AUTHORIZED BY TMIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />HE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CTY UPON ANY STOPPAGE OF WORh ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />