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x��a <br />�� <br />M�� <br />��� <br />� <br />��o <br />MA�y <br />pw� �! <br />�yH� <br />G <br />���" <br />O �A <br />I�� <br />f �'!ba'�l.�C.+�+,t�1: •c.,._. . <br />�818 "S �Z�—�7�' <br />Applicetlon For �} <br />PUBLIC WORKS PERMIT <br />f <br />Print or Type Only <br />_ri�.,� <br />, <br />Yl:i .s... � <br />PuOi¢ Wod� Permit • 2 O / <br />Biep OeDI.� <br />P���K wo,...�, s <br />To1e1Poe <br />Le�� �DY� Fee P�iE � �Jp� <br />Beience Due S `�r- _ <br />� <br />Describe Proposed Work <br />Prolect Address (il known) <br />Attech four (4) copies of olane for propoceA work - Draw to <br />• Property Lines <br />• Outline end dimensions of all exisling and <br />proDosed structures on the bt <br />• Ezistin9 and proposed ���i�Nes <br />�� <br />n NO <br />and note Ihe following as applicable: <br />• Centerline ol streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show mea5uremenl5 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in edvance • phone 259•8810. <br />2. All work ahall be pedormeA in eccortlance with this permit and cuvent City oi Everett Design and Constmction <br />Stendards end Specificetlons. <br />3. Ca�l Location Underground Service 46 hrs. belore you dig. TOLI FREE NUMBER 1•800-424•5555. <br />q. M ax Or��vc�.�at-� .�� o-rN Ar �'�u���-rrn-� �in.� = zO � <br />� <br />lppnved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone: 259-8810 <br />C� — I — `� Z. <br />92— <br />� <br />O <br />� <br />� <br />0 <br />a <br />ACKNOWLE�GEMENT OF CONDITIONS <br />The undersigned owner/app�icant hereby agrees �o hold and savu harm� <br />less Ihe Ciry ol Everett �rom a�y and ail claims for damages, cosls. <br />expenses, or causes ol action Ihat may arise because of installation <br />and maintena�ce of ihe impmvement or other righPoi-way use hereto <br />applied for and lurther agrees to remove same upon notice from Ihe <br />City and to replace public properry damaged Ihereby. <br />!� -�J ,(if s� ,r--u-s, <br />Si9naWre of Applicant Dat <br />WORK AUTHORIZED BY THIS P[RMIT MUST BE ST�RTED WITHIN <br />180 DAYS Of DATE PERMITISISSUED AND THEREAFTER IS TO <br />8E DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />� <br />