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Date-24'1S <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Publ¢ worts Veld,d a R 2Z// <br />bleo DePI I 174/ / 51 L) A <br />Public Wort Fee i <br />tolel Fee <br />Less Apol Fee Pei f <br />ftde eDue S �17Y0� <br />Owner Mallinn Ad ress' - City Zip Phone <br />C /TAT i A Cu .1LAI lk t/rn- A 71.3 S- It . F,,�„� �&a_o_�_— ass- asoan <br />Phone <br />Applicant Mailing Address City Zip <br />z <br />C <br />0 <br />ilea t P Krr/u Mc���'a _ <br />Describe Proposod Work _ - - <br />m <br />m <br />UJH <br />S <br />" ----- <br />e <br />Protect Address (it known)_ - <br />mo <br />Attach four (a) copies of plans for pr000a in work • Draw to scale and note the following as applicable. <br />C 3 <br />• Properly Lines • Centerline of street <br />I'n <br />• Outl,ne and dimensions of all existing and • hldicate North <br />= <br />props sed structures on the lot • Show any proposed grading changes <br />m <br />• Existing end proposed utilities N She, moasureir is <br />.o z <br />ycy <br />DO NOT WRiTF U_l UW THIS LINE <br />N <br />PERMIT CONDITIONS <br />< <br />m <br />1. All snits for Inspectioi . shall be made 24 hrs. in advance - nhone 259.881 5. ^ <br />O P <br />2. All work shell be performed in accordance with this permit e,rd current City of Everett Design and Construction i <br />Yj <br />Standards and Specifications. <br />1 Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. �e.� <br />m <br />N <br />G <br />v <br />Y. USC Elms>� vG l�aF�✓Ey C!/T. ri <br />N <br />1m <br />rn <br />� <br />� I <br />Y <br />OS <br />Ln <br />low <br />Z <br />C <br />-i <br />H <br />n <br />m <br />ACKNOWLEDGEMENT OF CONDITIONS <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 of installation <br />7 1� �5-- and met ce of the Improvement or other right- use hereto <br />from the <br />the <br />n notiwayce <br />/_ applied for end further agrees to remove same upon notice <br />for an <br />Approved Approved l�!GZ!t Ion Date City and to replace public propertyl damaged thereby. <br />Z7 <br />F'NAL1ON Date' !/ <br />Approved Constructed S nature of Applican Date <br />as <br />WORK AUTHORIZE BY THIS P RMIT MUST BE STARTED WITHIN <br />everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />0200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone. 259-P-815 PROJECT OVER 90 DAYS DURATION. <br />