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bate '' ��' ��' <br />Applitation For <br />PUBLIC W�RKS PERMIT <br />Print or Type Only <br />owner <br />Applicant <br />Mailing Address <br />r,�ry <br />Cily <br />i <br />PUELc WoiFs Po�mi1 r �� � �6 / <br />BIUB. DeO�. • <br />a�auc works <br />Tolxl Fea <br />Lesa nppl Feo PaiU s __ <br />BalancnDue s 200� <br />C�o z-,, zz - yr •ov�- i/- B3"/ <br />fi'_ G�Ei. 9�"ao3 <br />s� <br />nF.f �/- 5's3- 97a 7 <br />Describe Proposed Work Cr�.r�'r+��. Cohc..��<. c��ri,y ,r"+'r'�. �.��..� � ,.iNi��.,�nv �„-(�...�„�c ,yo„aM oC j., � �on r.� <br />i T— <br />�• r� <br />�l c%c G b �- n u c � % F c"I� 6 I � r.r � t s � F' I o n' F T�T--1; <br />[,i1/l �.ri � � ) I j I <br />R /`rc r./� A+�r.-eX yd Of �OW /`e��1 Nt'rn` I �l l�0' N� h� / la.�..iJw�r�n Y— �� <br />��. � �f v <br />Project Address (if known) <br />Attach four (4) copies of pians lor proposed work • Draw to scale and note the following as apUlicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Approved for <br />Approvad as <br />everett <br />e <br />• Centerline of sireet <br />� Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs. in advance • phone 259•8810. <br />2. All work shell be performed In accordance with this permit and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Locetlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-555�. <br />� l(%�!�7�� �O ,� O�Orv� � Ti �w.�6%�) <br />L✓�ceo' B-/ - 90 .(�'OPt) QZ%" l <br />O <br />ij <br />�GG <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett. WA 98201 <br />Phone: 259�8810 <br />-/r �o <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />�� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City ol Everett Irom any and all claims for damages, costs. <br />eeponses, or causes of action that may arise because of installation <br />and maintenance ol the improvemenl or olher right�of-way use herelo <br />applied for and further agiees to remove same upon notice irom the <br />Cily and to replace public property damaged thereby. <br />�' �� �-� � <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS �>F DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />