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Dste �19/86 <br />Application For ^ <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu011c Worka Parmit � �� _ /�� <br />BIOq.0ap1. e 4 86/16260 <br />PuOGc Warks Fee <br />Tatel Fae S — <br />Leaa AOG� Fee PaiE S-- <br />Belance Oue S ��'� �j <br />Lesaley �natruction 18204 Bothell �erett Hwy Bothel7. 98012 4�31-8866 <br />Owner Mailing Address City Zip Phone <br />Same <br />Applicant <br />Mailing Address <br />Ci�y ZiG ^ Phone <br />Describe ProFosed Work __CBB�''Lct�==nQ� e f�ilv h�� _ <br />Has'e 7249 90 W;ttov r p.k G7en <br />Project Address �il known) <br />Attach tour (4) copies of ptans for proposed work - Draw to scale and note the following as applicaule: <br />• Property Lines <br />• Oulline and dimersions of all existing and <br />praposed structures on the lot <br />• Existing and proposed utilities � <br />Y Centerline ot sireet <br />:i Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />t. All calis for inspectlon shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordarce with this pe��nit and wrrent City of [verett Desigu and Construction <br />Standarils and Specifications. <br />3. Call Location Undergrour.d Service 48 h:s. hetore you dig. TOLL FREE NUMBER 1•500-424•5555. <br />i%J��O'S!"-z_ .•� z.S FJ <br />Approved for Construction � ate <br />�� l'' � ' <br />� /- -, 7- �� <br />FINAL PECTION Date <br />Approved as Censtrur,�ed <br />everett PUBLiC WGRKS DEPAHTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />PhOne: 259-8815 <br />ACKNOWLEDGEMENT OF CONJITIONS <br />� <br />O <br />The undersigned owner/applicant hereby agrer.s to hold and save harm- <br />less the City ot Everett from any and all claims for damages, costs. <br />expenses, or causes ot action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and turthe.r agrees to remove same upon notice from the <br />City and replace public property damaged thereby. <br />_ � � � ��— <br />gnature of Applicant ✓ � Date <br />WORK AI�THORIZED BY THIS PERMIT MUST BE STARTED WITHIi! <br />780 'JAY5 OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BC- DILiGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCcLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO:ECTOVER 90 DAYS DURATION. <br />