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Appliwtion For ��` '` / <br /> � PUBLIC WORKS PERMIT Date <br /> PUBLIC WORKS DEPARTMENT Public Works Permil N ��Y��� <br /> 3200 Cedar Street <br /> Everett.WA 98201 259-8810 Building Permit p � <br /> Public Works Fee 5 �� `"^ K/' . <br /> TYPE OR PRINT ONLY <br /> , Mailing Address City Zip Phone f <br /> Owner <br /> � /3I'"`�f�� S £ S�� a/A 9�• 360-6�8-z9�- <br /> �.$Cd Zi Phone <br /> Applicant Mailing Address Ciry P <br /> Describe Proposed Work <br /> �� � -„� - sod +�,�.�.�. .� �D t ��� W <br /> d• S►.` � � <br /> V/ <br /> PROJECT ADDRESS(if known) <br /> o - 3ro4�a+ L`'�mr.� • l.�l/E • � <br /> Attach four(4)copies of plans tor proposed work-Draw to scale and note tha tollowing if applicable: � <br /> •PropeAy Lines `Outline and dimensions o1 all exlsting and proposed structures on the lot •Existing and proposed utilities <br /> •Centerline of sireet •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 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current City ot Everett Design and <br /> Construction Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> �{', �'er,p �i� s�e-!s d si���l�s o%an g f u ll -fi'�u . (/� <br /> GvrS vf�f'/ GY S��c w�l /(C �'�r�vd Rf �I /'Y�N��' � <br /> r � p /�cec�a-� '� � <br /> 0���'►'� Sh�� � /'��l,Yi.�D�C /'G� <br /> di'�cc�zti o-1��v51z w+�✓�r ,�,�✓ec�.>! <br /> G. -�i-a I �r d,'n,��d � ���%c uin''EJ ih1/xcy4nr <br /> �• �n 5�6/ �i�ol�Ti� H <br /> '7 �p �/aiv�� �✓' +'aG/c �S�la!/ �x p/itc� � G(ea./r� a� S � <br /> vn�r'l P����t,Ylg l��serf•ne� r��,Y�nre.��T -�✓ a[ Gh�ny,e u+�" <br /> c>s.e hcuk hr.P.ri/ rx PJ�utiC��t �t�✓ �6 G'c u.Cr'�-r��s'�►1,¢ �as <br /> � ob��7�� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> / The undersigned owner/applicant hereby agrees to hold and save harmless <br /> �� r�/ ���/Gl� the City of Everefl fmm any and all claims for Camages,costs,expenses,or <br /> %���u� ,� causes ot action th:it may arise because of installation and maintenanco of <br /> ApprovedforConstructior}�+ Date ' theimprovementorotherright-of-wayuseheretoappliedforandfurtheragrees <br /> � to remove same upon notice from ihe City and to replace public property <br /> / �_ Z Z y-� damaged ihereby. <br /> �! f��� <br /> F�L INSPE ION Date <br /> Approved as Constructed <br /> ignature ot Appli n Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN 180 DAYS ATE PERMIT IS ISSU D AND THEREAFfE IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />