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�, 1 � / <br />� �� Application For <br /> ����'�'� � ��w;,�ys_ d��BLIC WC4f�KS PERM6T �a,e �`��'��g— -- <br /> ° �'` � .�J �� PUBLIC WOFKS DE-PARTMENT �S��J <br />�N � Public Works Permit ft <br /> v��� 3200 Cedar Sireet �-�- <br />�� r+ Everett,WA 98201 259-8810 <br />{ �.�,«w ,c� Bwiding Permit k 60857 <br />�7t'�� ,; i'rFEORPFiINTJNLY Tj PUSTING� 1 � 'Q� — PublicWorksFee$_ �d <br />�. ,ar� 7 .'F <br />` �ANY .1SI.LISON coNST ro uox 6241 LYwrrtti�oon �;�n 9s036 425-750-0615 <br />�"'^r�-�..x,;:,'b� Ozanc� - - pAnilinc�Ad�ross City Zip Phone <br /> � ii <br /> r� ci+ 'r <br /> �N .::"'� <br /> 5��` I,pplican� Pdailing FlLdre;; City Zip Phone <br />�j4Y�IX�. <br />': i '�., L'escribe Proposed Work hEid HU�:SE - BASIC 2022 � <br /> �,c a�-��� � <br /> �� <br /> . I � PROJECT ADDRESS (if known) �LZ S — �"�`'JE- -� LOTS 12 & 13 � <br />���� "� Attacti four(4)copies of plans for proposed wrnk-Oraw to scale and n�t=_tha following if applicaUle: � � <br /> ��� ' . •Property Lines •Ou'line and dimensions of all vxistiny and propo::ed siructures on the lot •Existin9 and proposed utilities <br /> � <br />. ��, �;; •Canterline of street •Indicate NoAh •;how any proposed grading changes •Show measurements ��„ i <br /> DO NOT WRITE BELOW THIS LINE G �; <br /> PERMIT GONDITIONS: �IIr �:� <br /> 1.All cafis for insoection shaii he made 24 hours in advance- phone 259-8810. �� I <br /> 2. All work shrll be pertormed in accordance with this permit and current City of Everett Design and � <br /> Construction Standards ai�d S,�ecifications. �' � <br /> 3. Call Locatio� Underyround Seriice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> �� �:' <br /> �`, �bv!►'lc� f�Wti 5 po u�S '�D 5 f c�C SeWP�+'. Si c�e Se1NC✓� � <br /> i <br /> �� �%lr G"� 5� �(�J' 1 , � i', <br />��—��`� �, a:� <br />��r,SRTk'� <br />,S�' ��_a �((((� <br />;1.�i�✓.lv ..i_� . . � �� <br /> �i!R" ,.,�0 . . <br /> �� 'r,�/ ....'�tJ�.�� _. i'} <br /> ;.c�r..� <br /> ;'� <br /> ',s.� �� c�: —._ �� <br />� _ � <br /> ACKNOW�EDGEMENTOFCONDITIONS � <br />��� y�''� M�/A�/-�,� The undersigned owner/applicant hereby agrees to hold and save harmle.:,. <br /> ���''� �j q� ihe City of Evere�t from any and all claims for damages,cosis,expenses,o: i <br /> App c��e for Con:��_ iction l D e causes of action that may arise because of installation and maintenance ol � <br /> ��' theimpmvementorotherrighbof-wayuseheretoappliedforand/uAheregrec:�. i.� <br /> r �-- lo remove same upon notice from the City and to replace public property . <br /> �--r��'l $-/�_ 5'eJ damaged thereby. ��:;� <br /> FINAL INSPECTION Date � <br /> Approved as Consimcted I� <br /> �igr icant ate �a <br /> WORK AUTHORIZED BY THIS PEF M141T PAUST BE STARTED WITHIN 180 DAYS OF�ATE PERMIT IS ISSI!ED AND THEREAFfER IS TO BE DILIGENTLY PUPSUED TO <br /> COMPLETION.THIS PERMIT MAY 3E CANCELLED 8�THF GTY UPON AIJY STOPPAGE OF�NORK ON THIS PROJECT OVER 90 D�YS DURATION. �' <br /> ... �. .. �. _. ._._. ._.__ . . . _ <br /> }. j . . . . . . . '. . . . . - . _ —_.' _.r� <br /> . �.. . . . .,. . � � . �. <br /> i <br />