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SrNT 7c !/.4S17iN� /7 -7-8 7 <br />Date���L <br />�.`� ~ , Appiicatian For <br />PUBLIC WORI�S PERMIT <br />Print or Type Only <br />Describe <br />— Maiting Address <br />,�-R Go,�sr /�.� <br />Mailing Address <br />wo�k �%L/ �%%�LL� � <br />Project Address (if known) <br />✓ <br />Pu�lic Works Parmil • 86 — 5�65 <br />Bitle� Deo�. + <br />PubliC Worke Fee s <br />Totel fee <br />Lass Foo� Fea Paid S ` <br />Balanca0ue S `�`�� <br />/yl��fE ,QFDFncO <br />Zip Phone <br />YNMi✓ae d %O�pW 7 <br />�iP / �f.n� / / <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the Ioilowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing ancS • Indicate North <br />proposed structures on lhe tot • Show any proposed grading changes <br />• Ezisting and proposed ulilities � • Show measurements <br />PERMIT CONDIT�ONS <br />1. All calls for inspection shall be made 24 hra in advance - phone 259-8815. <br />2. All work shall be periormed in accordance with ihis permit and current City of Everett Design and Construction <br />Standarcls and Specificationa <br />3. Call Locatien Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� L.>ae.� Ta BE ,l7cwE P�'�e AP�/,e�wEo <br />.�.E'E>L/fi li9fE/� /Z — 8 — g6 /�qP,/ qirAc�f'E� <br />t / <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 88201 <br />Phone: 259•8815 <br />12/10/86 11:i5AM ( <br />OF1itiB0�r17 f3S.00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />s <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance ot ihe improvement or other right•of-way use hereto <br />applied for and further agrees to remove same upon notice trom ihe <br />City and to replace public property damaged thereby. <br />��: �CJ �1�L�i�' l Z��0,��6 <br />Signatu�l9pplicant _� <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 PERMIT MAY BE <br />CANCELLED Bl' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PI70JECT OVER 90 DAYS DURATION. <br />