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SEi�/� �� —/c� <br />;" oete/z �6 r36 <br />� Appliwtion For <br />PUBLIC WORKS PERM{T <br />Print or Type Only <br />Describe Proposed Work <br />Project Address (il known) <br />ozo � <br />Ciry <br />City <br />S��v � <br />PUUhc worka Permil • v v_ ��� <br />eiae oeo�� • <br />Pue�mWrcl.sfr a <br />TOP.I Fee <br />Le3s �DP� �-B! PaiE S _T — <br />np <br />BdlanCe Due S <br />S, <br />Atlech four (4) copies ol Plans for proposed work - Draw to sc21e and note the lollowing as applicable: <br />• Property Lines • Centerline of streel <br />• Outline and dimensions ot all exi;ting and • Indicate North <br />proposed siructures on ihe lot • Show any proposed p�ding changes <br />• Existing ai+d proposed utililies • Show measurements <br />Zsz—y�z3 <br />�ylvic c E <br />Phone <br />rnorc <br />PERMIT COD� DITIONS <br />1. All calls lor inspection shall be made 24 hrs in advance - phone 2rJ9•881 5. <br />2. All work shall be parlormed in accordance wilh this permit and current City ol Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Undnrground Service 48 h�s. before you dig. TOLL FREE NUMBER 1-B00•424•5555. <br />� /,�J�,Q,E To BE liv�/E PcC.2 tJET6iPmi�V�9r�oN <br />O� NO.✓ -S/GN/i/C�ln/CE� - S�� �OfL —B(o <br />��Ei �f� /�a%�86 <br />Approved lor ConstruC ion � � Date <br />�je�/� !� zo -y7 <br />'�INAI. INSPECTION Date <br />Approved as Constructed <br />everett PUBIIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everelt. WA 98201 <br />Phone: 259-8815 <br />�� <br />1�7{{��n���,' 1{��."SO OQ <br />R�UOOE'!4i9 <br />�.���,;� t�a�3�»9 <br />ACKNO�VLEDGEMENT OF:,ONDITIONS <br />W <br />H <br />� <br />� <br />,•1 <br />L J <br />The unAersignetl owner/applica,�t hereby aflrees to hold and save harm� <br />less the City ol Everett irom am� and all claims for damages, costs, <br />expenses, or causes of action Ihat may arise because ot installation <br />and maintenance of ihe improvement or other righ�-obway use hereto <br />applied for and lurther agiees lo remove aame upon notice irom the <br />Ciry and to replace public property damaged Ihereby. <br />,�y <br />�i•/� <ll��`�"n _ -c 2 `,i` <br />Sign ture uf Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAF'TED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREF.FTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLEiION. THIS PERMIT MAY BE <br />CANCLLL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />