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�a�a��,Fo, 81►r �d <br /> � PUBLIC WORKS PERMIT °a�e-- _ <br /> PUBLIC WORKS DEPARTMENT Public Nbrks Permit M ��z 3 5 <br /> 3200 Cedar S�reet <br /> Everett,WA 98201 259�BB10 C'�a�� <br /> Building Permit M�2 <br /> TVPE OR PRINT ONLY Public Nbrks Fee S Z Z � � <br /> Q��+�c.�i oH���� �r��-��c� `I�3 �-IPi�'�r �C�dtk W'ft 9�d� � y����o��z <br /> Owner Malling Address City 2ip Phone <br /> .J�-��_ <br /> Applicant Malling Address City Zip Phone <br /> Describe Proposed Work }�'�� �U ��^� '���-lc.�� lL�,�C�.�r�l- i n - W <br /> _ bc,�1: v�c� �v �—j�v�� 1-e �z�_�/\G�.��r�., � <br /> � / yj /� -�{ �Q � <br /> PROJECTADDRESS(if known) `� �1 �3 �`��`v l.-�^2- _-CVQ/�+1 �'`''/ ' � <br /> Attach lour(4)copies of plans lor proposed work-Draw to scale antl nole the following If applicable� <br /> •PropeAy Lines 'Outllne and dimensions ol all existing and proposeC siructures on the tot •Existing end proposed ut�l�iies O <br /> •Centarline of street •Indicate NoAh �Show any proposed grading changes •Sho�v measurements � <br /> DO NOT WRITE BELOW THIS IINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be mada 24 hours in advance-phor�e 259-8810. O <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. TOLI_FREE NUMBER 1-800-424-5555. � <br /> '{, Eros;�r con-�ro l �r d,'rcc t� �,j �Gd ,'�s�u,�✓ � <br /> S FHstiuii �o f ,�».p�� ��l�uu�,f �,..��,-�fi��ed. � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITION� <br /> ' � �/1_�J� The underslgned owner/applicant heraby agrees to hold and save harmless <br /> V[ � �y yG Ihe City ol Eaerett from any and all claims for damages,costs,expenses,or <br /> P.ppr ved lor Cynsiructiop, Da e causes ol aciion that may arise because ol Installatlon and maintenance ol <br /> ` the improvemenl or other right-of-way usa heralo applled br and fuAher egrees <br /> /!J to remove same upon notice from the City end h replace public property <br /> . t� d f'"�l' �, ��-0����7cT _ damaged thereby. � <br /> FINAL INSP[C110N pale /� � { <br /> APProved as Consiructed / ' I ,.�1 � � � /`/.�� <br /> 4�V. M � � � <br /> Signa W re ol Applicant Date <br /> WORh AUiHOPIZI:D BY 71115 PEFiM1T MUST 8E STAqTED WITHIN 180 DAYS UF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION iHIS PERMR MAV BE CANCELLED BY THE CIN UPON ANY SlOFPAGE OF WORK ON THIS PRQ�ECT OVER 90 DAYS DURATION. <br />