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yRy17, <br />O X7x <br />yCy 1 <br />CSO <br />H :d <br />O pCO <br />'i CAA H <br />OH <br />HCi <br />/�VIg <br />0. 0 <br />9zy <br />t t•a H <br />rA <br />Fa <br />C�GrA <br />[d <br />HOryn <br />I <br />C_i <br />Date% '2-- D-91 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Tn �'OSTING __ �a,iR? <br />Public wort Permit <br />Bldg oopl. a <br />Publm works Fee S <br />idol Fee <br />Lees APpr Fee Paid 5 <br />ealencs oue $ <br />GY <br />City Zip Phone <br />Applicant Meiling Address <br />Describe Proposed Work _ t4sFiz <br />A-723 5 hur fie- l <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the Centerline as of (Peet able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Q, IF -tJ,xZ Lai., Itieeds -�.o P�"'-'P 'E,S szw�`r��., Ll.e s�sl-cwrbha <br />di;ckarc -'M6Da3'dkv(e.(t0"eV-Ckcwet, <br />bell dp) PrLff 11�. �^L vmArlh.z+le rush bt <br />CKMVleI;zeJ avid �t�"fp��E 6►ro.i V1-61 <br />vrc M •4:.1,\rti cv, V e, 4-Tw.wi G Sde SIN. K� {wle io be <br />P r Gy-Of`kA <br />S hose. 6') <br />a-% pW a-v Y`G W`n��5i�wti. <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />W <br />r� <br />NM <br />W <br />0 <br />IZ <br />0 <br />V� <br />0 <br />(L <br />AC NOWLEDGEMENT OF CONDITIONS <br />The undersigned ownertapplicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public property damaged thereby. <br />zz'% <br />Signatur f Applicant Date <br />BY THIS P/m IT MUST BE STARTED <br />WORK 180 DAYS TOF AUTHORIZED <br />PERMIT IS ISSUED AND THEREAFTER ISHIN Tr <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPFAriE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />