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Date �/1 / l�'�O <br />% ' <br />Application For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Unly <br />l hr \JC�t� � Z�LS <br />Owner Mading <br />�c �, : , � <br />Applicant Mailins <br />`_ t� <br />Describe BroPosCd_Yll,ork R�` C � `"''� ��� <br />vuoec �vo,h: re,mn . �"/le �J � <br />eioa Deo�� • <br />Publ¢WorkSFP.B s <br />Totai Fee <br />less AD��. Fee Pa�O $ n /� /'` <br />BatanceDuc S ���'/ `����`�` <br />�'s7r, 1 z52—�143 - <br />2ip Phone <br />�S2c�1 ZSZ- <br />Zip Phone <br />Project Address (il known) ��`^^ �� � � � `�� � 'n <br />Attach lour 14! copies ol plans lor proposed work - Draw to scale and note the lollowing as applicat is: <br />• Proper:y Lines <br />• Outline and dimensions ol all existing and <br />proposed slrucW res on ihe lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremcnts <br />LIN <br />All calls tor inspeclion shall be made 24 hrs. in advance � phone 259•881 5. <br />All work shall be perlorm2d in accordance with this permit and current City of Everett Design and Consir�ction <br />Standards and Specilica�ions. <br />Call Locatian Underground Service 48 hrs. before you dig. TOLL fREE NUMBER 1•800•424•5555. <br />.u�;1' l��`L <br />�, , r ���L2,��/E � <br />�i.c ���- ��• � �� �"� <br />Approve or Construction , Date <br />��x/a-�� `�/`./-�� <br />FI—N� h:SPECTION Date <br />Approved as L���'�-::�ted <br />everet� PUBLIC WORKS DEPARTMENT <br />� d200 Cedar SVeet <br />Everett, WA 98207 <br />J Phone:259-8815 <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant hereby agrees lo hold and eave harm- <br />less the City ol Everett Irom any and all claims lor damages, cos�s, <br />eapenses, or causes of adion that may arise because ol installation <br />and maintenance of the improvement or other right�of-way use hereto <br />applied br and lurlher agrees to remove same upon notice Irom Ihe <br />Ciry and to replace puUlic property damaged thereby. <br />��/ �� <br />� : �� , , a �E_ <br />6jpn ure 1 Appli ant � Dale <br />WORK AUTHORI EO BY THIS PERMIT � UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED �Y THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />