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Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />�9f'ropo ep Work <br />'v r �/1 <br />Pro{ect Address (if known) <br />��b <br />����� ��7 �� <br />Mailing Address <br />S ��//7���viy� � <br />Mailing Address �— <br />� "!P- r� ir �! <br />� cc l - <br />� _ � _ _. <br />�'°.� �ss 5��T7 <br />,3�vC�_ /GdQrv� r'� <br />PUEIic Worka Pprmil • J �v <br />BiOp. �eot • <br />PuElic Woiks Fee j /9 <br />Tolal Fae � � <br />Lees Aool Fae P�iE i /� <br />Bai�nce Due = � f`_[%�/ <br />,��.o�l� <br />Pho e <br />�'S�i —5��c�v <br />_'�33-7.�3i <br />2ip <br />D�G � �" T <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the following as appllcable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol ell existing and • Indicate North <br />proposed Structures on the lot � • Show any proposed grading changes <br />• Ezisting and proposed utllities � Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hra in aCvance • phone 259•881 5. <br />2. All work shall be pertormed in eccoraance with this permit and current City of Everett Desifln and Construction <br />Standarda end Specilications <br />3. Call Location Underground Service 48 hra belore you dig. TOLL FREE NUMBER 1-800•Q24•5555. <br />� Oni S'�TLr /Yl��/�� �c�i�'c�0 cJ/T/�/ CiT�i <br />/=/Ec�o /i✓J'�'cc,ziye ��v� 7� �cGini�lii►2�- <br />C'L c�Yc'i/YL� <br />ir <br />.Gi�J/T;� " <br />M <br />/Nv,��= <br />'�' � .p�c i7�.E' .d�iJTl�y <br />rpprovea as constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Strtet <br />Everett, WA 98207 <br />Phone: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and sava harm• <br />less Ihe City of Everett Irom any and all claims for damages, costs, <br />ezpenses, or causes of action thal may arise because of installation <br />and maintenance of ihe improvement or other right•ol-way use hereto <br />applied for and further agrees to remove same upon notice from Ihe <br />City and to replace public nr erty damaged thereby. <br />/� <br />Signat ot Applic py�e <br />WORK AUTHORI D BY TH�S PERMIT MUST BE FiTARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTIY 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 />M H <br />H '*1 <br />�� <br />M <br />C <br />� H <br />� Z <br />H <br />� � <br />M � <br />� N <br />� <br />m <br />. � <br />� <br />� <br />� <br />� <br />M('� <br />L*7 <br />