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Da[e�� � �I-� <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Tyae Only <br />;� � <br />qpplicant <br />0 <br />htailiny Addres5 <br />I.ti�;j <br />Descri6e Proposed Work �i%� �^i�{-1�( �1�' �T �%�z-.+ V <� <br />Projec� Add,ess (i� known) <br />���Y <br />z� <br />Pu01¢\YorksPmmlla � -�� 7 � <br />Bltlg. OepL s <br />Pubhc Works Fee $ <br />Tolai Fee <br />Lecs ApO�� Fee Paid $ _ <br />BalanceD�o $ ��-: n'� __ <br />���'-�: '.'ti nii� �'i <br />Z <br />•� ��'i l�-��- Zk� (Z- <br />Zip Phone <br />Attach �our �41 rooies of plans for prroosed work - Draw to sr,ale anA note the followi�g as apolicable: <br />• Property Lmes <br />• Outline and dimensions of all existing and <br />proposed slructcres on the lot <br />• Exis:ing and proposed utdities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Shew measuremenis <br />PERMIT CONDI'lIONS <br />1. All calls �or inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424-5555. <br />� ` /, y�' /� !'L �2 ���C�l�tvLa;-�Ci Cc eCe 4 �..2� �![ rx_i'�..� <br />C�'C il y[4-l(. <br />! � L/-G�'/L /=c. /t.� <br />��'LcUG.c ��t��-� ' <br />� <br />, <br />� �,., _-T-�ci <br />s y,� ��� 4�v:� ��y�=� �2� «.�f .�� <br />.���cv[� c� �Ci%-' :R.y�s�c;.-. y Q��a-fir� �o �L�/l: > <br />�J � U <br />� �GvtP/ G� �,�V• �JLc�LI <br />P.) C�-2 �/ ' <br />!/ <br />yia.4 !< �yL - <br />.�!_� /�t�7v� c cC: c�" , <br />i <br />' /7� !�7C.:,�-Y �� i � <br />Approve Construction te <br />' .i <br />l"E����� /"'� �3�; <br />FIN I SP CTION ' Date <br />Approved as Construded <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett. WA 98207 <br />Phone:259-8810 <br />ACKNOWLEDGf_MENT OF CONDITIONS <br />W <br />� <br />_ / <br />The ur�der;igned owner,�applicant hereby ayrees to hold and save harm� <br />less ihe Ci�y of Everelt trom any ar,d all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance ot ih? improvement or oth�r righhof-way use hereto <br />applied for and further agrees to remove same upon nolice irom the <br />City and to replace public property damaged thereby. <br />�, �' � <br />. �� � c-� <br />ignature of plic nt Date <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 PENMIT MAY 8E <br />CANCELLED C3Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />