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Dake 3-2� % <br />� Application For <br />PU�LIC WORKS PERMIIT <br />Print or Type Only <br />Sc .,. � D, ��T '� �- i U.1 h.< <br />Address <br />City <br />O % ��jp <br />Pu�licWarhSPermita C7-�J <br />Bltlg. Ocpt. a <br />Public Works Fee <br />Tolalfae g <br />LesSAppL Fee Paitl $ <br />BalanceDue S <br />11i�L`i G�O <br />339L/.s'� O <br />Phone <br />3 �4_., � �—. <br />Describe Proposed Work �� i�-�-..- a- , v :j� _. c.l.- rn J� ..-. -c ,.J +/,/ y5"x� iT .- <br />Prolact Address (if known) <br />Onl SCfi�C�OG <br />ff '7 �h. <br />Attach lour (4) copies o( plans (or proposed work - Draw to scale and note the lollowing as a�cplicable: <br />• Property Lines <br />• Outline 2nd dimensions of all existin9 and <br />proposed structures un the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />.�n_ <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Shov, measurements <br />7. All calls for inspection shall be made 24 hrs. in advance • phone 259-8815. <br />2. All work shall be performed in accordance with ihis permit and current City ot Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />y ,�-�.� y.,��,t�� �-�a;�, <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-881 S <br />��._�;z�✓��,-,� �:�>r,�. �u���F�,_ . <br />#i00067'�SG <br />Di'T.20 ec,r� �,`, <br />�4��i_il� ..._. '._, <br />ACKNOWLEDG[MENT OF CONDITIONS <br />The undercigned owner/applicant hereby agrees to hold and save harm- <br />less the Ciry of Everett irom any and all claims for damages, cosis, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righPof-way use nereto <br />applied for and lurther agrees to remove same upon notice Irom the <br />City and to replace public property damaged ihereby. <br />/P�.i.a — ��1'22s�'�r <br />Signature of Applicant � Date <br />WORK AUTHORIZED �Y/rIiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK Otv THIS <br />PROJECT OVER 90 DAYS DURATION. <br />