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��Fp . ���$�9� <br /> �i��� PUBLIC WORKS PERMIT oe�B ' <br /> PUBUC WORKS DEPAR'TMENT Pubib YbrW Pertnit N ����_ <br /> 3200 Cedar Street q <br /> Everetl,WA 8B201 259-8870 Bullding Permlt N �o �I� <br /> IYPE OR PRINT ONLY Public Works Fee E�� <br /> " 4a S-iSa ro7uZ <br /> �, �- e��i '�� Iw•� 9� f�l p i� CJ�Mc �C.�cr�c.� W��18��3 <br /> Owner Mailing Addresa �� — <br /> � Zlp Phnne <br /> S�l�- <br /> Applicant Mal�inp Addresa City 2ip Phone <br /> Descrihe Proposed WArk _ G�� �h GC�r�(��r�cJ � � �yy�,p '`yt,��� �c�vt�__ � <br /> _ o�_dl�v'�' M l��kYr.rc)l _vo � � <br /> PROJECTADDRESS(ifknown) _ � � � 3 (�JG./(1�C.�a.1 �nGt�1� �VQrt9) ,�f1 �ta�3 � <br /> Attach four(4)copies ol plens lor proposed work•Uraw to ncWe end note tha fo�lowing If appllcable: � <br /> 'Property L1nes 'Outline and diinenslo�a o1 ell exiedng antl proposed siructuras on the lot •Exlating end proposed utilllies O <br /> 'Centerline o1 street •Indicete Nonh �Show any proposed grading changes •Show meawremenin <br /> DO NQT WRITE BELOW THIS LINE � <br /> pERMiT CONDITIONS: � <br /> 1.All calls for Inspection shall be made 1.4 hours in advance-phone 259-8810. <br /> 2.All wcrk shail be performed In accordance with this permit 9nd curcent City uf Everett Design and o <br /> Construct(on Standards and Speci(i�ations. <br /> 3. Call Locatlon Underyro�nd Sen•Ice 48 hrs. before you dig. TOLL FREE NUNIBER 1-800-421-5565, � <br /> � ��P�9in�i��,�` u��� �� co.v��3'iy�b o .� s,r.�.- � <br /> � <br /> s �'0 7-��y- ciry �,tis�c�� v��tiis a <br /> J <br /> C���c<�1'7/9� �7�5 7l`i�� 4'�� ct�r�iQ"�=i'7o/� <br /> �� fii✓f'� G��'icOiirJ� oF �'�i���� <br /> � ACKNOWLED(iEMENT OF CONDITIONS <br /> Tha undersigned owner/epplicant hereby egrees to hold nnd save harmless <br /> �� the C!ty ol Everatt from any a�id nll cla!ms fo�damages,costs,ex{»nses,cr <br /> p or C nslrucGop� ��B �r— owses of actlon that may erisa becnuse of Installatlon and maln�enanca cl <br /> / / t7e improvement or othRr rlght-al-way use herato epplied for and fu�her sgreas <br /> ro remuve samu�pon notice Irom the City and to replace puulle property <br /> dameged thereby. / <br /> FINAL INSPECTION pye —"—"'— � � i � <br /> Approved as Constructed /�S //I� <br /> / /Y <br /> SlgnaWre of Applicant Date <br /> WORK AUTHOfiIZED 8Y THIS PERMIT MUS7 BE S"fAFTEG WITHIN 1t�0 DAYS OF DATE PERhAIT IS ISSUED ANO TH[REAfTER IS lp BE DILIOEN'ilY PUpSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLEO flY 7HE CITY UPON ANY STOPPAGE OF W07K ON hi15 PROJECT OVER BO DAYS DURATION. <br />