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Iw'/ �^' <br />� <br />TYP[ OR PRINT ONLY <br />Appiication For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett. WA 90201 259-8810 <br />Date �` �3 % o' / <br />Public Works Permit # 7 (��.�(e __ <br />7 <br />Building Permit a <br />i <br />Public Works Fee 5 2G � <br />��`s,.-d:, <br />Owner Mailing Address City Zip Phone <br />i <br />�t-%i G�C� <->�,� ��C, <br />Applicant <br />Describe Proposed Work � <br />�z�� �.�,Y«.�— <br />PRGJECT F.DURESS (if known) <br />�-s�� � S��tC�o��ud� pg���, - <br />City <br />�� <br />Attach fou� (4) c�pies of plans for proposed work - Draw lo scale and note the following if applicable: <br />Phane <br />•Property Lines 'Gutline and dimensions of all existinq and proposed structures on the lot •Exisfng and proposed utilities <br />•Centedine ol simet •Intlicate North •Show any prop�sed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be periormed in accordance with this permit and current Ci;y of Everett Design end <br />Construction Standards and Specifications. <br />3. Call Location Undergrou�id Service 4J hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />¢ .i <br />. �Z'Cr .-��, cr�� �o ��, � <br />�`�-_3->8 <br />}I VS6ti:: <br />�1ThcF �G.i� <br />`]T�AL �r.�,��' <br />y 0'-4�.:1 <br />� <br />i= >'o!:: (=: .::C. �: _ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ilie under.:i�ned owner/applicant hereby agrees to hold and save hartnless <br />the City o�� Everett from any and all claims tor damages, cos' expenses, or <br />causes ot action that may anse because of installation ana � aintenance of <br />tl��e impmvement orother right-ol-way use hereto applied for an� tunher agrecs <br />to remove same upon notice from ihe City and to replace public property <br />dama9ed ther y, <br />/ <br />..\� <�C � -t.L <br />S��nature of AppPcant Date <br />WORK AUTHORIZED �Y THIS PERNIT MUST BE STARTED �VIiHIN 780 DAYS OF DAi E FEHAIIT IS ISSUEC 1ND MEREAFTER IS TO BE Di' � 3EN7LY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS PHOJECT OVER 90 CAYS DURATION. <br />