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Date 5_10_93 =______= la P�S1�17G—���9-Dl� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />& Pat Morton <br />3232 56th St SW <br />PuDlic Works Permll • �� � � Q / <br />r <br />BiE9� DeO�. • � <br />Puoiic Works Fee <br />Total Fee S <br />Less AOD� Fee Paitl S <br />Balance Due S � <br />iIO�-.3y583�283/ -+ B8� <br />ooz-3zZyoi�63� -iss-� <br />Everett WA 98203 wrk <br />8-6°d2 <br />rnone <br />Owner <br />Applicant Mailing Address CitY Zip Phone <br />Describe Proposed Work SFR to office/apt u[dxdug}axx � �/p,�u Q�o�oX �h <br />� _ . ._._ <br />Project Address (if known) <br />AtYuch four (4) copies of plans for proposed work - Draw to <br />• Property Lines <br />• Outline and dimensions o( all existing and <br />proposed structures on ihe lot <br />• Existing and proposed utilities <br />and note the following as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra. in advance • phone 259-$810. <br />2. All work shall be peAormed in accordance with this permit and current CIty of Everett Design and Construction <br />Stendards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424-5555. <br />`% S�� /�lo�� fo i�e dor�' �er PCQ n a.���-adec� on <br />,j�a��/3 fu� �he c�i/er'e7'f /'v6Ci� !.�/o.tks ,j)�,pf <br />���oy a �i`ar/�> <br />5," %ie �Pov� fo� d�., s�x,vfs ii�fo Sio��-Sewe�-- <br />���PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett irom any and all c�aims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of lhe improvement oi other righFof•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to reptace public property damaged thereby. <br />��` '^ � �v-/�-�'�_ <br />Signature ol Applica 1 Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS Pf:RM1T MAY BE <br />CANCELLED BY THE CITY UPGN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />