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� Mafir.atlon F« 7� � ` / U <br /> PUBLIC WORKS PERMIT Date <br /> PUBUC WORKS DEPAHTMENT PubAc Worka Permtt A' _ �CJ/� <br /> 3200 Cedar Sireet — <br /> Evnretl,�NA 98201 259•8810 Building Pertnk M <br /> TYPE OR PRINT ONLY TO PO STI N G � 1 `; � public Works Fee S '4'd <br /> ��a.,e. S C�w�bs , 3izz 1i.��P�.w,a. l4Ye, ��tf, �,,r4 5xze� Kzs—Zs9-cs79 <br /> Owner M iling Address Ciry Lp phpne <br /> �ika- � �oow�.� � ,�•o• �Ox I 17f� S�w�,�rw'sl� �•�4 9b'291 �fu-�lit�-svy� <br /> Appllrant ailing Address Ciy Zap phq�e <br /> Descrit�e Proposed Work ��kt� C ��Gl. b�U��1 1 Y 17Mr�..Q Qrte� �p ■ � ■ i <br /> i <br /> ►`� � G�""�r• �"' I <br /> � � <br /> PRW ECT ADDRESS(if known) 3�2-Z 4' ��2 6' BY•r..��-.�y � <br /> Atlach four(4)eopies of plans for proposed Hork•Draw to scale and note the following H applicable: � <br /> •Property Lines 'Outline and dimenslons of all existing and proposed structures on tha lot 'Existing and proposed utilkies O <br /> "Centerline of stieet •Indicate North 5how any proposed grading changes 5how measurements � <br /> DO NOT WRITE BELOW THlS UNE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspoction shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be pertormed 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. TOLL FREE NUMBER 7-BCO-42MSS65. L <br /> �, sio,� ,��., ����,�t � h� c, �, ls�P�Q��4�.). �.uf <br /> M♦ I <br /> G(3 f� Px,3t�'�� sidcbcwr,� �v.a4,f,6Jd�,,„,�� � <br /> 5 �srk,ti7 wr�s� n-c¢vf z�( t�P/,�1a bC¢. �,1�+� �✓;►Lma„-ft.� a <br /> s��/ S;ze, �o�1��is , �OA - ..c�. .. _ ,. <br /> ��� <br /> . �. .: , ,Dav,�5 <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> -� /�/�Q The underslgned owner/applieent hereby aprees to hold and save harmless <br /> � �� the City of Everetl from aoy and all claims lor damages,costs,expenses,or <br /> Ap rored for Cony. Lct on Dat � causes of action that may arise Uxause ot Installation and maintenance o1 <br /> Q�� thn tmprow+ment orothar rightwl-way usa hereto eppAed for and tunher agrees <br /> to rertwve same upon notica from the CNy and to ieplace public propc7ty <br /> �� �,,—� � 'f-]�7 .y'8 dama9edthereby. <br />� F1NAL INSPECTION �Date /� <br /> ApPruved as Constructed 1 , � � 7� _ � � <br /> D r <br /> Siynature f Appli�ant Daie <br /> 1K AUTHORIZED BV THIS PERMIT MUST BE STARTED Wlh!IN 180 DAYS OF DATE PERMR IS ISSUED AND 1HEREAFTER IS TO BE DILICaENTLY PURSUED TO <br /> °LET10N.THIS PERMIT MAY BE CANCELLED BY TFiE CITY UPON ANY STOPPAGE OF WORK ON THIS PHOJECT OVEA 90 DAYS WRATION. <br />