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y'^tirR ;".,: � � i<..,: <br />'.r',:= r e;,.,. .," . <br />M1 <br />_ " a.. <br />'y - ^�tk�.�� <br />Date S S � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />'7 3 �. <br />Mailing Address <br />PuElicWorksParmil+ ✓-�%'i <br />BItlO� �ept. t � <br />PuElic Worke Fee <br />Toial Fee $ <br />Less Apnl Fee Paitl S <br />Balanco0ua 5 �Q�O <br />3 <br />Applicant Mailing Address City Zip Phone <br />r� <br />Project Address (it known) <br />Attach lour (4) cepies of plans for proposed work - Draw to <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utili�ies � <br />PERMIT CONDITIONS <br />and note ihe fullowing as applicable: <br />• Centerline of sireet <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measureme�ls <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•$81 5. <br />2. All work shall be pertormed in accordance with ihis permit antl current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Ser•iice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />-- - - �:�y Nc�E.���Y <br />� E,L'OSia� CGNJi�_'OG %O f�E OOitl{' f.'� lJi�'�': ?c= n d1 <br />%f,'c" �'iT�.� ,r�:i:l_'/C G�U�S TiLS�cC%o.c' � <br />�`-, fiLL /D 6E r-',��'fffE.O �/Tf,� iC�T7^,..JiNG C�iF,�GGS O� <br />tio �/d,c�' T</9n� S' iN /�.G.s�i- ��ovzur� OB/OB/86 9:28Ati i <br />/ <br />�; cSLUt�E F�[�i.eb Cr�/CG .�ESLt7 /�/ ?ri� Ot✓tiE%e P��2@'h't S�O.00 <br />.f'E-SiOEvcE �E'E.oi9i.��.�/i fl+/D ?, ci�CAci.tlG f•�S f_'EC�i c���0 520.00 <br />.ay r.�� f UdL/G Gt/��?G'I J�.??� ACKNOWLEDGEMENT OF CONDITIONS <br />�appiovea as i,onsuuc[eo <br />evcreu PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259-8815 <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to holC and savc harm� <br />less the City of Everett trom any and all claims for damages, cosis, <br />expenses, or causes of action �hat may arise because of ins(al!ation <br />and maintenance of ihe improvement or other right-obway use hereto <br />applied for and turther agrees to remove same upon notice (rcm the <br />City and to replace public property damaged Ihereby. <br />p r � <br />\'�%�`' 7 yl !�'' G NC 1c %S'—S'—F/� <br />Signature ot Applicant Date <br />WORK AUTHOliIZED BY TH�S PERMIT MUST �E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />