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Applioatbn For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY T(I POSTING --- <br />Date 5/19/99 <br />'/fZ <br />Public Works Permit N <br />Building Permit F B62513 <br />Public Works Fee $ 36-00 <br />Bk <br />COUNTY 3000 ROCKEFELLER EVERETT 98201 <br />Owner Mailing Address City Zip Phone <br />Describe Proposed Work <br />Mailing <br />BROWN <br />PROJECT ADDRESS (if known) / or U/ — <br />rnone <br />Attach four (4) copies plans for proposed work - Draw to scale and note the following if apr licable: <br />• Property Unes • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities <br />• Centerline of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <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 his. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�ei° cc�y S��Qefs /CLeah �x QCC firms' <br />.l, �f/ Cann�con O� Oito/�vJt� C/75/ <br />,S�ztJO/' sys�� S�SaLG %Jtl/G 2 9�' frQO. <br />1. <br />A%af/ or <br />Xe <br />ralo LQco&I <br />04ln'eje0l X1;6✓4%6 <br />pro, or ns ruc ion 7 Datel <br />FINAL INSPECTION Date <br />Approved as Constructed <br />S"4e& <br />Se�n� {� 1 ,I,►1 as �S <br />W <br />♦ttttf� <br />Y/ <br />0 <br />z <br />0 <br />r� <br />Y/ <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arse because of installation and maintenance of the <br />improvement or other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public property dam. <br />aged thereby. <br />signature of ApplicantDate <br />WORKATVW1REDBPFFOUNTMn ",Jq'al�r77YIFMANYF7UPPAGE OAF WORK ON TMSSPPRO,ECTOVEReg DAYS DURAT10N.DILIGENTLY PlhiE0.JED TO <br />