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�" <br />TYPE OR PRINT ONLY <br />___�V� _Sv�;_e_r <br />Owner <br />__-_�1.`Plican� _-_—_- _ <br />Describe Propc <br />— - - -----N��- <br />nni����:�e�� r�� <br />PUBLIC WORKS PERMIT <br />PUHLIC WnRKS DEPAqTMENT <br />3,^�0 Cedar Slreet <br />Everett, WA 98201 259-8810 <br />I,R�iling Address <br />Date .. _.'��ZGJ,-1U_.._--------- <br />, Gr�], �Q <br />Public Works Permil a . !V/?J[�C/____.,_ <br />Building Permil k __. � . <br />Puhlic Works Fee $ _ �i <br />wg_�8�r� _ z� 3ss-o��� <br />Ci1y Zip Phoce <br />Mailing Address Cil� Zip phone <br />PROJECT.4DDRESS(iFknown) __ %Z�Jin ���u-i �j�Vd, <br />Attach lou �4) copiea ol plans lor pioposed work - Drnw to scale and note ihe fol o ing d a�pllcable: <br />•Propeny Lines •Outtine and dimensions ot a0 existing and proposed sUuctures on ihe lot •Existing and pwposed ulilities <br />•Ccn7crline ol street •Indicate North •Shuw any pmposed grading changes •Show measwemems <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIGNS: <br />1. All calls f�r inspection shall be made 24 hours in advance - phone 255�A810. <br />2. All work shall be pertormed in accordanc� with this permit and , �rrent City ot Everett Design and <br />Construction Standards and Specifications. <br />3. Call Locatinn Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />6{, vt�avk �j��4i �e C�o�e �5 1�G✓ T��'�a�ou�� %Ji�vt, ��cl�e�> <br />I �� ( <br />G� ��� (1��2�1 �[8, <br />ok � M�k� <br />APP�" 9o�ns��Nc�i-t6t� D��(���f.i2_— <br />� ��_i �c l/t' l t��.-f:� /. ���._`/�% <br />FlNAL INSPECTION Date. <br />Appmved as Constmcted <br />/ <br />� <br />� <br />� <br />Y/ <br />� <br />Q <br />� <br />� <br />O <br />♦�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi�ned ownedapp;icant hereby agmes to hold and save harmless <br />Ihe City ol EverEtt fmm any and all claims tor domages, cnsis, expenses, or <br />,:auses ol action that may arise because of installation and maintenance of <br />tie irnprovement or other right-obway use hereto applied for and furiher egrees <br />k remove same upon nolice Imm the Cdy and to replace public pmpeAy <br />d�maged thereby. <br />��_ ���c.�-�. <br />Signalure of Applicant Date <br />WORK AUTHORIZED 9Y iH15 PERMII AIUST �E STAflTED WITHIN 180 DAYS OF DAIE PERMIT IS ISSUE� AND THEREAF7ER IS W BE DILIGENILY PU9SUED TO <br />COIdPLETION TIiIS PERMIT MAV BE CANCELL[D BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />