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r <br />� <br />� <br />L <br />L <br />L <br />Date � �� <br />Application For <br />PUBLIC WORKS PERMIT � <br />Print or Type Only <br />, �. 5�+.� <br />qpplicant <br />Describe Propased Work <br />Project Address (il known) <br />�3 i�� IZ? <br />Mailing Address <br />i31c� IL'-` St <br />Mailing Address <br />����A/[ � / <br />'AI� <br />l <br />� <br />a�er�wo�ksvo,ma. v�aa3 <br />eieo. 000i.. <br />P�ei¢ Woika Fee <br />Totel Fee <br />Lese AODI Fee P�IO S <br />Baiance Due „i�''b �— _ <br />qs z�� � ��- iz�x, <br />Zip Phone <br />� � �'kZi <br />Ciiy 2ip <br />( <br />Attach lour (4) copies oi plans lor proposed work • Draw to scale and note ihe follov.�ing as applicable: <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions ot all existing and • Intlicate Norih <br />proposed structures on ihe lot • Show any proposetl gradin9 changes <br />• Existing and proposed utilities • Show measurements <br />PEflMIT CONOITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be periormed in accordance with ihis permit and current City ol Everett Design and Construction <br />Standards antl Specilications <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FR[E NUMBER 1-800•4Z4•5555. <br />� �.\�� w <br />� � �L�CGc ,�u%�/fd'T�� <br />. �- ` � o ,J �czo i.y�J <br />. �t- �� � � <br />� � .� ° � <br />� . f�6'< «.9��- <br />-.7 ,� �. �v. <br />'1 <br />W <br />H <br />� <br />� <br />� <br />0 <br />� <br />� <br />� <br />a <br />,�����Jsi��� r�,e ��/� <br />C[i.E'p�� �i1%«"/�AEOWLEDGEMENTOFCONDITIONS <br />The undersigned owner/applicqnt hereby agrees lo hold and seva harm- <br />less ihe City of Everett from any and all claims for demages, cost�, <br />expenses, or causes ol action that may arise because of installatlon <br />and maintenance ol the im�rovement or other righhof�wey use hereto <br />applied to� and further agrees to remove same upon notice from the <br />City and to replece public properry damaged thereby. <br />_( <br />Signatur f Applic t Date <br />WORK HORIZ D� Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DA PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO,IECT OVER 90 DAYS �URATION. <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259 �8B 1:, <br />V <br />i�l <br />J <br />J <br />1 <br />