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��� <br />m�x <br />C H <br />9Hti <br />r <br />� H 7�tl <br />�C�/1H <br />H <br />z <br />�H17 <br />��g <br />(�]r C] <br />Cy� <br />Hy <br />g �' <br />c�CGfn <br />thr�y <br />�H�n <br />HOf/� <br />�a e <br />Date � � �'� <br />Application For <br />PUBLIC WQRKS PERMIT <br />Print or Type Onl� <br />Describe P�oposed Work <br />IO P�S?ING _--'Z j3-�i <br />Address City <br />5�-_L�I!'-- <br />Mailinc, Address <br />��uoi�cWoixsParmn� �� �p��. � <br />emu �mot. � g �l1-- <br />Pu�i�cWorwsFce 5 <br />Tmai Fee /� <br />Less ApPI. FrtB P�iO S—/ ,�+.�-e--� <br />ar����P:;�� s <br />� - <br />.L$� - <br />Phone <br />Zip Phone <br />Prolecl Addres5l�� known) <br />_��-�, �_ �7 y=`'�Jv� � <br />Allach lour (4) coPies of plans lor proposetl wo�k - Draw to scale and nole the following as applicable: <br />• Properry Lines <br />• Outline and dimensions ol all ezisting and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• CeMedine of sireet <br />• Indicate Norih <br />• Show any pioposed grading changes <br />• Show measurr.ments <br />PERMIT CONDITIONS <br />7. All calls br inspection ;hall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with ihis permit and current City ol Everet� Design and Construction <br />Standards and Specifications. <br />3. Call Localion Underground Service 4B hrs. betore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />.�% <br />P��O_•� ��o «n�. <br />FINAL wsre���v�. v � <br />Appro�ed as Constructed <br />eecretl PUBLIC WORKS DEPARTAIENT <br />� 3200CedarStreet <br />Evere!t. WA 98201 <br />Phone."59�8510 <br />��,��J �'-/� ��-�8 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />Z <br />O <br />♦�^ <br />V♦ <br />� <br />a <br />The undereic�ned ownenapplicant hereby agrees to hold and save Ymrm� <br />less Ihe Cdy ol [vereU Irom any antl nll claims for tlama9es, costs. <br />enperses, or causes ol action Ihat may arise becaus� ol insfallation <br />and maintenance of the improvement or other ric�hPo�-way use hereto <br />applied lor nd Wrther a�r s to remove same upon no!ice from ihe <br />Citq an � replace p lic � wnerty damaged the�eby. <br />/ <br />l %l'2��i'�- �v'�S- �� <br />raWre ol Applicant Date <br />':JORK AUTHORIZED BY THIS PERMIT MUST BE STARiED NITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D!LIGENTLV PURSUED TO COMPLETION. THIS PEAMIT MAV F3E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />