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TYPE OR PRINT ONLY <br />Describe Froposed Work <br />Application For <br />PUBLIC WORKS PERM�' <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />EveretL WA 98207 259-8870 <br />l3b ta u� 'rp�•..J <br />Mailing Addre55 <br />Mailing Address <br />Tns�LL <br />- "�" r � " �.�.('� f_ <br />ax sv ec 3 a- <br />Ini.�� aK A✓a <br />��ie_—a/-8��y -- <br />Public Works Permit k _/9��,3Q <br />Building Permit # <br />Public Worl:s Fee S �� 00 <br />1� <br />d�r !� i 7 <br />Zip Phone <br />- o��o <br />Phone <br />�„ �� n� ..�. <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: � <br />'Property Lines •Outline and dimensions of all exisling and pmposed stvctures on Ihe lot •Existing and pmposed utilities <br />'Centedine of street •Ind;cate Norih •Show any proposed grading changas •Show measuremeMs <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Gonstruclion Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />/, LC/O?�C. rG !x• C/Os�2 �� 7/GYL^�/Pa���GhS CG�'s7�2� <br />,�- 9-99 (eo�fi a�4d�ed) <br />J /%Z{S LoZ� �?US f 6e <br />�: I�y�4 CC s�i-Q �, _�� <br />QGrpSS PXisfi�f �i- C` <br />7 �„y O�LiL'r^ LrJOr/� <br />S/�CL i'r�vi.-� �, <br />� -se�d�c� f1 soa� Qs �ossiriC�. <br />wi�6ih 3 wks� <br />L��+'�J <br />, <br />� <br />0 <br />i <br />r/ / <br />O <br />a <br />as d.,�z � 6y �h� cr�ys Pa6l.� �i�Es <br />�0 62 ds-ia ai� �/:s si% <br />Q�o: �.ohaG Persr�%�, <br />c�� C�eQh ovf 6'�•�,;,y Cr�cti 6asin, <br />.�rosPecfmh, <br />ACKNOWLCDGEM[:�lT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />Ihe City of Everett from any and all claims for damages, cos�s, ?xpenses, or <br />causes of action that may arise because of inslall.���o� and ma'ntenance of <br />the improvement or other right-of-way use hereto applied for and furiher agrees <br />to remove same upon notice trom ihe Ciry and to n:place public propetly <br />damaged thereby. <br />���' /� <br />Signalure of Applicant � ��� <br />WORK AIITHORIZED BY THIS PERAAIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND �iHEREAFTEH IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. ThIIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />