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--� !o � o�' �`������� �� � <br />ApplicatiutFor <br />TYPE OR PRINT OP:i Y <br />Sr.cNn� �}/ek <br />Owner <br />� /�". <br />Applicant <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS �PAFTMEN! <br />3200 Ced treet <br />Everett,WA9820g 259-8810 <br />� � � <br />� a � <br />`'' S� � �o/ <br />%rri.S �� C. : � 2l0 �cc:,r7 fiJ� �� <br />Describe Proposed',Vork <br />PROJECT ADDRESS (if known) <br />Mailing <br />\�� <br />S�o <br />> c, - 9 �=`' <br />� <br />�� /. <br />�:8�9_-I���' '�` ��"l <br />Public Works Permit R ���� -- <br />Building Permit p <br />Public Works Fee $ � <br />BP <br />oF <br />Phone <br />Phone <br />Attach tour (a) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines •Outl6ie and dimensions of all existing and proposed stmctures on the lot 'Existing and proposed utilities <br />•Centedine of street •Indicate North •Show any proposed gr2ding changes •Show measurements <br />PERh11T CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this �ermit and current City of Everett Design and <br />^.onstruction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dia. TOLL FREE NUMBER 1-800-424-5555. <br />,/ / <br />. �,�yt�'LG cc. toc� �,1��fi�i/1C_2 �� C(7�� a���t•,c,✓ <br />� � 0.�' <br />5, /??�;c//c.�� Qi�t�/ /'X'Cc'SS�G'/^ (/ Z i-UG� �/'22 ��G C�O/77-�"'G'L <br />/ /J � r <br />2S CY.i��c.�n_� ��/ T`i.' �L�%LiC Cc,'vr.�s clY�s�e�j�c%i-- <br />�. �%Ch5-�4.�� 5��7 7'eh-i.,� 2S S/�c�.i� c�, <br />���� c��y 5���,-�d�.,�,/�Z��� �j - <br />, <br />C( /��Q G:l (�/ J <br />i� <br />� <br />� <br />V♦ <br />m <br />0 <br />� <br />� <br />� <br />i♦A <br />V♦ <br />OA <br />1.�. <br />�' ACKt:J'NLEDGEMENT OF CONDITIONS <br />/ l,��� The undersigned owner/applicant hereby agrees to hold and save harmless <br />„ 4_ q-q 7 the Ciry of Everetl from any and all claims for damages, costs, expenses, or <br />�l�" causos of action that may arise because of installation and maintenance of <br />,qppfo� � onstructio Date the impmvement orother right-o4way use hereto applied forand further agrees <br />� � to remove same upun notice trom the City and to replace public property <br />i ��,5 �f damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constmcted � _ <br />ig a re of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUSI BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THER ER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK 0� 7HIS PROJECT OVER 90 DAYS DURATION. <br />