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r - _ . <br /> APPIiCallon Fa �— � ` Q � — <br /> � PUBLIC WORKS PERMIT °�18 � <br /> PUBLIC WORKS DEPARTMENT Publlc Nbrks Permit p q8/� <br /> 3200 Cedar Slreel <br /> Everett,WA 98201 259-8010 <br /> f Building Permit M <br /> i�� TO POSTING �ov 13 � <br /> TYPE OR PRINT ONLY Public Works Fee!� <br />� <br /> ���,� S Coow,bs , 3 i z z Br�P�, 14.re, �.�t� i.,..,4 qs�e l HZs-Zs9-cs7 9 <br /> Owner M Iing Address Ciry Zlp phone <br /> � �` ke. Coow�.� � ,1��-�X 117fr .SLw�w�'sl� �4 9fi,29 J K2�—�I18—S9Y�l <br /> Applicant ailing Address City Zip Phone <br /> DescribeProposedWork �'��� C.��C[� 64��1� �'Y /,Vt�r..p RKa �p � <br />'�I ' � <br /> 5�,�..,z. l i►.e ., ,S,�d ��.. <br /> n � <br /> PROJECT ADDRESS(if knawn) _3 I Z Z- 4" �I2�' Dr.n,/.,+�,y � <br /> Attach four(4)copies ot plans for proposed work-Drew to scale and note the tollowing R appilcable: <br /> •Property Unes 'Outline and dimensions of all existing and proposed structures on the bt •Existing and proposed utilities O <br /> `Centerline ol street •Indicata North 5how any proposed greding changes 5how 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. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and I <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �4, slo�c h� ��c�e.�� -�o Hcw C, �3. <std p�an�9vz.). �c� � <br /> �Q � P�x,3��'n� 5 idc6GwC,r �u,dti f,b/d/j�,,y�,�) � <br /> 5 P�,k,�y �,�s� ,�.� t,r ��Pi,�� bc� G;�y ��;►�,�„-�..�,, a <br /> s��l S;ze, �d�ff��is , �40A _ ..c�, �' - _:. _'. <br /> _ ir9.s c. <br /> �':r_:? =:i . �l�uia� <br /> i"u`;.q'_ C <br /> ,.,�. <br /> L.: � � . .iA) <br /> ACKNO`NLEDGE�AIE�R Of CONDfTIbNS <br /> The undersigned owner/applicant hereby aprees to holtl and mve harmbss <br /> 7 8 the City of Eveiett from any nnd all clalrtu fa damages,costs,expenses,a <br /> Ap roved for Con ct on Dat causes of actbn that may arise becaux of installatbn end malntenance ol <br /> the improvm�ent a other i'v,�M-ol-v.rey use hereto applied for end Mther ag�eee <br /> � /" to remove same upon notke hom tha City and to re{�laca pubNc propeny <br /> X/ cf3� —f �-)�7 -/rg deme9ed therebY• <br /> FfFJAL INSPECTION Date <br /> Approved az Constructed . <br /> ` 7--C — Z b <br /> Signature f Applicant p� <br /> �AUTHORIZED BY THIS PERMIT MUST BE STAHfEO WffHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfEq IS TO BE UILIOENTLY PUflSUED TO <br /> LE110N.THIS PERMR MAY BE CANCELLEO BY THE CfTY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS JURATION. <br />