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� <br />TYPE OR PRINT ONLY <br />pphca��on For <br />PUBLIC �JURKS P�R�VIIT Date <br />PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Street <br />Everett, WA 98201 259-8870 <br />9G <br />Public Works Pertnit A��ll� L/ L' <br />Builtling Permit N <br />� <br />Public Works Fee $ C- �i � <br />'r.�l.:,:,il:,i i�G„ii5 1: �u� :ihfi� AVi i' i;�� �L.�; �; i,''i, `sSb-<4�i5 <br />Owner Mailing Address Gty Zip phone <br />Applicant Mailing Adtlress City Zip Phone <br />Describe Proposed Work <br />.,..., i:tiGsi.: - <br />PROJECT ADDRESS (if known) _-<< � C <br />�Y2�� !-�Jt <br />Attach four (4) copies of plans for proposed work - Draw to scale antl note ihe following if applicable: <br />•Propeny Lines 'Outline and dimensions of all existing and proposed stmctures on the lot •Existing and proposed utilities <br />•Centedine o1 sireet •Indicate North •Show any proposed grading changes •Show measuremenls ' � ' � �- � ' � <br />r� <br />vvivv� vvn��cocLvrr InIJL11VC � .'l.f .,_ <br />PERMIT CONDITIONS: �;, ,;; <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. :'.'�.'' �1 <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />fichf Im, �ootlop nwotl iu dnuua¢�� ��nu ;r ;U �: u ut iui <br />Pav� i6 ivcwnp ti'om p�apeily Imc �o edge u{�pu�•e:maui ��� � �:�in ,,�.�ti ;�� �. ,, .r. ,,, niii� u� iml�i�. <br />ri�ld ot=�r�iry uun- be limiled tn 17.' to rerhue n�ool�. <br />!.)evcloper ia re�ponsible 1i�r co�itroUiqq sil� nu�oil�fioro S. ird :��; c� . llii� �v�il includ�•. but i�, u�.�1 <br />limiled to. iustnlliug:i ue�v t'B prr ,tandEud fP102 ;md c;�ii,t�ucliqe tm ouKiill ln 16o dr}umiqe cow'an <br />�l6 FZSiVi'II118 ✓�. �:.11.W� <br />W <br />H <br />- <br />� <br />/�/� <br />V/ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save hartnless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-ol-way use hereto applied for antl further agrees <br />to remove same upon notice trom the City and to replace public property <br />damaged thereby, <br />.. �N"•. '�-�., � ���� -"� , <br />_���"-__ . ,,% <br />Si� ofApplicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF OATE PERMIT IS I6SUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPFAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />