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Ds�e_��y <br />Application For <br />PUBLIC OfVORKS PERIVIIT <br />Print or Typo Only <br />�Tiy 1a0EI�ER 936 M�ki].tso Blvd. <br />�� /�� <br />Puolic Works Pnrmil • <br />0109� Dept • <br />PubllcWvrksFee s �l .. O U <br />Talal Fee �"' <br />Lesf RpO�� Fae Pe�tl s <br />Bslance Due S '�� �r� � � <br />#c�77a� <br />iton 98203 259-2398 _ <br />s� <br />SAME <br />Applicant Malling Address City Zip Phone <br />Describe <br />of a 30 foot Drive Way Aocx�ss bo Lote 14 anri 15, <br />v aooess to • <br />� s*ti+ of said l.ot 15 for a distanoe <br />a <br />�� <br />will <br />Prolect Address (it knQiYll}�a ,.,.. ..� ...-,- -- -- —'---- <br />qranteci by the owner aocmes Lot 14 to Lot 15. <br />Attach four (4) copies of plans lor propoced work - Draw lo scale and nole Ihe lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed strudures on the lot • Show any proposed piading chan�es <br />• Existing and proposed utilities • Show measuremeMs <br />PERMI7 CONDITION•.' <br />t. All calls lor inspection shall he made 24 nrs. in advance � phone 259•861 5. <br />2. All work shall be performed in accordance with this permit and current City o1 Everett Design and Construction <br />Stendards and Specifications. <br />3. Call Locntion U�derground Service 48 hrs. belore you dig. TOLL PREE NUMBER 1•F300•424•5555. <br />��(�4vt.'l.=Y I.ne��nL u� Cif.ve.w 1) wo'Y Jb �P71r�%, <br />y42� r✓t� a+� ro�..:r ,�ow�s,��t .%� ex�sT�.,� �lo�'�_ . <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />P.�one:259�A815 <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWL[DGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agmes lo hold and save harm� <br />less the City ol Everett Irom any and all claims lor damages, cosis, <br />expenses. or wuses ol action Ihat may arise because oi installation <br />and maintenance ot the improvr.ment or olher right�of�way use here�o <br />apphed for and turther a9rees to remove same upon notice irom the <br />Ciry and to replace public property damaged thereby. <br />� /� �/ 1'L��l I <br />Siqnature ot Appl nt �ate <br />tNORK P.UTHOF; ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1d0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE UILIGENTLY PURSUED TO COMPLETION. THIS PfRMiT �4AY BE <br />CANCELLED BY THE CIT'l UPON ANY S10PPAGE OF IVCRK ON TH�S <br />PFOJF.CT OVER 50 DAYS DUI7ATION. <br />