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LT • � -Zf:, `f" <br />Date �`?//��U <br />� �I <br />llpplication For <br />P;,��LIC WORKS PERMIT <br />Print or Type Only <br />� <br />TG � <br />PuEim N'o�ks Parmil • �� / <br />914p Dep1. • � �J� <br />�—i <br />Nuooc Worhs Pee <br />Tolal Fee S <br />Less ApP�� Fee PaIJ $ ^ <br />Dalance Ouc $ �l'� <br />� <br />Phone <br />Applicant Mailing Address Cit <br />Y Z'P Phone <br />Describe Proposetl Work <br />Project Address (if known) <br />u <br />Atfach lour (4) copies ol plans for proposed work - Draw to scale and note Ihe tollov.ing as applicable��O/9O 3:40PM <br />• Property Lines • Cente�line ol slreet � <br />• Outline and dimensions of all existing and • Intlicate North j����747 <br />proposed structures on the lot • Show any proposed gratli��pRngesf���� <br />• Existing and proposed utilities • Show measu�ements <br />k00027677 <br />PERMIT CONDITIONS END II �720.00 <br />1. All calls for inspeclion shall br, made 24 hrs. in advance- phone 259-8810. 1171^5 f650,00 <br />2. All work shall be peHormed in accordance with this permil and current City ot Everett Desig��� Cons <br />Standards and S�ecifications. �L� i�3,�Q <br />3. Call Location Underground Service 48 hrs. before you di9. TOLL FREE NUMBER 1•$00��5555.s�•� <br />r�c►+ sso.00 <br />FLN CH az.�7 <br />q. AFPL"� G�T� NI A� P1E�' 0 TG� �- �vNl P B SRCH f4.50 <br />`-��'-"_ �, -t_� <br />Fe'�'- `fH I S tilc�>'�C-= . i'� `_>O Pfcov i CHECK 42859.7'1 <br />. C�E 3` �iArl�`tZIZ <br />rl/�N +lo�c- ot�1 �r�_1 VAT� fyc�t�-�r�-�� rtc, p �sc.�-�.�z�. <br />T��-S�rzc- L`t�t' inr�p , T�-�cN c,�znvi�r`� �c.c�� acL2oss <br />C- i'T�c' R.D.��l. TO S� t,1L�� MA l N. <br />.� <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar SVeer <br />Everett, WA 98201 <br />Phone: 259�8810 <br />OOOpqp772 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The untlersi9ned owner/applicant hereby agrees to hold and save harm� <br />Iess the Ciry ot Everelt Irom any and all claims lor damages, cosls. <br />expenses, or causes ol aclion that may arise because ol installation <br />and maintenance of the improvement or other ric�htrot�way use herelo <br />appGed tor and lurther aprees to remove same upon notice from ihe <br />City and lo replace public pwperty damaged Ihereby. <br />.,�y�...,��� �� nyyncau� • Daie <br />WORK AUThIOR12ED Y Tfi1S PERMIT h1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON P�IS <br />PROJECT OVER 90 DAYS DURATION. <br />