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� <br />TYPE OR PRINT n�!LY <br />Cwner <br />Describe Proposed Work <br />Application For <br />PU�LIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT � <br />3200 Cedar Street � �.' <br />Everett, Wq 98201 259-8810 • <br />�� POSTING N�' 2 z Z000' <br />Address <br />�6- sY5/-79'3�j' <br />PROJECT ADDRESS (if known) 7 D <br />., q <br />,/ i <br />oata _ Zr/Z 5��� _i <br />Publlc V��orRs Permit # ����� <br />6uildinc� Feia ;1 N _ . <br />Public Works Fee $ �J s �C ��111CWiT►� <br />��c �zS- 86� yz so . <br />9�''£� a 2 �- 5'ss syrti <br />Z�P Phone — <br />_ rAk �1Z3= 85�t� (o �F6 � <br />Phone <br />Adach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outllie and dimensions of all existing and proposed structures on the lot •Existing and proposecl utilities <br />•Centerline of street, •Indicate North •Show any pmposed greding changes •Show measurements <br />_ _ . .- . ..••• � �- .,��vvv i nio urvC <br />PERMIT CONDITIONS: <br />1. Ail calls for inspection shall be made 24 hours in advance - phone 259-881U. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-8Q0-424-5555, <br />4. �5 P�,. ��rro�� � ��� <br />/� � /l �� �'� LWL� <br />Approved as Constructed <br />¢-2d-9� <br />� �� 2/Z,$�/9% <br />ACKNOWLED3EMENT OF COND7TIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from �ny ard all claims lor damages, costs, expenses, or <br />causes of action that may arise because of installation and mafntenance of <br />the impiovement or other nght-of-way use hereto applied (or and further agrees <br />to remove same upon notice from the CiTy and to replace public property <br />damaged thereby. <br />�� � z -zs-9g <br />� a���,�,_� Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE S?qq7ED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE OILIGENTLY pURSU DaTO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CIiY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />