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Date ��/f/ � <br />Appfcation For <br />p�1�LiC WCYRKS P'�RN11T <br />Print or Type Only <br />�i � � <br />Owner <br />����"� <br />Applicant <br />�=" <br />Address <br />Address <br />PuCt¢ Worka Permil� �'�� � � <br />i � <br />BIEp. PeoL + �.�� � <br />Public WorkS Fee S <br />Tolal Foa <br />LassAOGI. Feo Peitl S /' <br />Balanca D�e $ Z�� �V <br />9'%z" <br />ac�it; !-Z�c=;z� d %d`I�� 355 -yY91 <br />City Zip Phune <br />City Zip Phonc <br />i <br />Describe ProPosed Work ��%si dL� -?S CL�iDE COAJC�Yc7Z � a� /Vc"[t�i-y -- <br />Projecl Address (if known) �f�T ��f <br />Attach four (4) copies of plans for proposed work - Draw to s:;ale and note the fc:lowinc� as applicable� <br />O Property Lines • Cen�erline of street <br />• Outline and dimensions of all exisling and • Indicate Norih <br />proposed structures on the lot • Show any Groposed gradin9 changes <br />• Existing and proposed utilitias • Show measuremenis <br />I. <br />PERMIT CONDITIONS <br />1. All calls tor inspeclion shail be made 24 hrs. in acvance - phone 259-$81 5. <br />2 All work shall be performed in accordance with this permil and current City ol Everetl Design and Construction <br />Slandards and Speci�lcations. <br />3. Call Lor,ation Underyrand Service 48 hrs. before you dig. TOLL FREE NU�df1ER 1•80�•424•5555. <br />" ' /G/5`�5'S� <br />� �� /5���-��.� <br />ApprovedTor �pnsty�¢fl+pn �� ate <br />� /Z-3/��°( <br />FINAL IF ECTION / `- Date :. <br />Approveo as �onsiruc�ed v <br />everett PUBLICWORKSDEPAf�iMENT <br />I � 3200 Cedar Sireet <br />Everett, WA 98201 <br />/� Phone:259-8815 <br />PCKNOWLEOGEMENT OF CONDITIONS <br />The dndcr;igned owner/applicant hereby agrees to hold and save harm- <br />le;s the City of Everelt from any and all claims for damages, costs, <br />expenses, or causes of action ihal may arise because ot installation <br />�nd mainienance ot the improvement or other right�of-way use hereto <br />applied lor and Iwther agrees to remove same upon notice Ironi tlie <br />City and to replace puqlic properly damaged thereby. <br />/.. <br />u <br />/�/-�G <br />Sig ture of Applic�fit "�'" <br />ORK AUTHORIZED BY THIS PErlM1T MUST BE STARTED WITHIN <br />780 DAYS OF Dr1TE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE UILIGENTLV PURSUED TO COMPLETION. THIS PERM1IIT PdAV BE <br />CANCELLED o'! i�'�{� CITY UPON AtJY STOPPAGE Ut` �`JORK ON TFIIS <br />PROJFCT OVFR 5G UAYS DURATION. <br />