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M� <br />a�R <br />9Hxca <br />F3 x <br />1-3 <br />WH :f <br />xx N H <br />MHs <br />OH <br />9H� <br />t�CO2H <br />C]17 CHA <br />C+9 <br />ZHCQ <br />HOCA <br />Date�90 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Publlp Wons Permtt is / O — O __ <br />Bldg Dept.* <br />Public Works Fee <br />Total Fee $ <br />Less ApPI. Fee Paid <br />Balanca Due $ <br />ge03 -�. C9s1n0 /d_ �✓f. 9B2y 41 319`9-08 7/ <br />Mailing Address City Zip Phone <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />0 <br />A17Z <br />W <br />Project Address (if known) 5`DD — 3� fh �• b,C� 70— z� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: v <br />• Property Lines • Centerline of street ♦^ <br />• Outline and dimensions of all existing and • Indicate North Cn <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements /gyp <br />/ W <br />I Csat DO NOT WRITE BELOW THIS LINE <br />0 <br />PERMIT CONDITIONS <br />' 1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction i <br />Standards and Specifications. <br />® "'F 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />'� CD? Sf.-vc fi o n �0 6 Edon c P,, /�Ca ti s A��ro ieo� O <br />�e 6y fS� �vereffPv�lcC✓orfs dePf Oh /D-zs=90 <br />S �2rmiy� /Sr Corsfrucor o' f!e l�eu� /r/efCohc� <br />.ea 'ass, <br />l <br />' ACKNOWLEDGEMENT OF CONDITIONS <br />\o 0 <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett, from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />AD p vedd f nstruction ^ Date City and to replace public properly damaged thereby. <br />FINAL I TION Date r <br />Approved as Constructed Signal re of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />