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Date_c�L_`��� <br />Apolication For <br />PUBLIC WORKS PERMIT <br />Pri^t or Type Only <br />�.v�33 ('o�.s%'. 2� 2� OIIKf; J�u� � <br />Owner Mailing Address � <br />Applicant <br />Mailing Address <br />Pu01ic V/arhe Permit • "" � ` � � � <br />eiea osci.. ���� /7Q/ 3 <br />Pueiic woika Fee S <br />Tolel Fao <br />lee� Apol Fao Peia s � <br />BuluncoDue S O . <br />�crZo <br />Zip <br />Ci�Y ZIP <br />DescribeProposedWork C���,..$�'���%/ 1�/ �(•� ���'�^=<<�—!« S• <br />L a!- ln�M �� P r �� ��i� <br />Project Address lif known) <br />Attach lour (4) copies of plans for proposed work • Draw to scale and nole the following as applicable: <br />• Property Lines <br />� Outline and dimensions of all ex-sting and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ef street <br />• Indicate North <br />• Show any proposed grading chanpes <br />• Show measurements <br />7 <br />PERMIT COND! (IONS <br />1. All calls for inspection sh,all be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construclion <br />Standerds and Specificaliona <br />3. Call Location Undarground Service 48 hrs. betore you dig. TOLL FREE NUti'IBER 1•800•424-5555. <br />S� i�'OO�'-Tvf' ,�,P�C/�•cJAGE /i2U�ST ,�F �p�JSi,f'nG LE� <br />PiC'E�E.2fli3CE� ��l1To C,Pc'�sl, <br />U, <br />i� � � <br />�% i .%'/ �-�� <br />FINAL IySP N Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF COtJDITIONS <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owneqapplican' hereb�� ngrees to hold and saee harm- <br />less lhe City of Everett irom any and all claims for demaqes, costa <br />expenses, or causes of action lhat may arise because of installation <br />and mair.tenance of the improvement or other righi�ol�way use hereto <br />applied foc and further agrees to remove sane upon notic� Irom Ihe <br />City and to reploce public property damaged thereby. <br />��L-'^� �' �.� � % / � d�� <br />Signature ol Applicant -- Oate <br />WORK AUTHORI2ED BY TH S PERMIT MU.^.•.'i BE STARTE� WITHIN <br />180 DAYS OF �ATE PERMi� IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUF� TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />