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pppliwtion For Uate 2_ ` � � / � <br /> � �UBLIC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT Public Works Pemiit M � <br /> 3200 Cedar St2et <br /> Everetl,WA 98201 259•BB70 Building Pertnit M <br /> 7YP[OR PRINT ONLY Public Works F2€5 �iJ � <br /> � <br /> 2a6-3s3�ss,2. <br /> , }�-« i 6' r F.v �a� .�y 3l 13e vA�.,,R�-i ��:—�.°�7 9 8��3 <br /> Owner Mailing Address City Zip Phone <br /> �� 1� <br /> App�iwnt Mailing Addross City Zip Phone <br /> DescribeProposedWork �PIU6 LuA�/ F�v>'V]��df}'flu/A�/ � <br /> �o�✓c S� - F d - F.. <br /> � <br /> PROJECTADDRESS(if known) .�J � � . � <br /> Attach four(4)copios ot plans for proposed work-Uraw to scale and note the following if ppllwbie: � <br /> •Property Llnes 'Outline and dimensions of all existing and proposed structures on the lot •Ezisting and pmposed utillties O <br /> 'Centedine of street •Indicate North "Shov�any proposed grading changas •Show measurements � <br /> DO NOT WRIT[ BELOW THIS LI�" <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shali be made 24!iours in advance- phone 259-8810. O <br /> 2. All work shall be pertormed 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 /> �. !.'✓'i veU� :✓l✓sf �- ���rJ�tr' f6 Qi"a aa�li�z-C� � <br /> � / 0 <br /> _ 6 L .� , f � o Sd-P�,� a <br /> �` � i e �-t, �� i� �r � ---_ <br /> ` ��l'% J " C�l�-�i`-� � l.�i� �I C� <br /> v <br /> —l-9� �� CC i�� �' � <br /> � Q�;':�%.7 i I'_!�Si S! :-_..�;i'.�,:.�, . . <br /> � S-° t c�o �„ � �� C :�o�a9�ro�a <br /> c � � �'�l� ✓J�-l-...e G�✓o(�(�ivt 1�w� �^,.:1�2'! S'S.'JD <br /> �QL25� . , ( �,!.�., , s,� �, <br /> �e ��t � �� —� �-5 � 0�� �� � . �� �cs� � �,� �� <br /> ,/,Z (/�GGC�GG CGt��/LG �v L�c�t . Ic.� l2 0 w (il 11 $�c�'� =_ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �— The undersigned owner/applicant iiereby agrees to hold and save hartnless <br /> / � Ihe City ol Everett Irom any and all claims tor damages,costs,expenses,or <br /> `' causes ol actlon that may arise because of Installation and maintenance of <br /> —r� r o ruc�n Dat� theimprovememorotherdghbot•wayuseheretoapplleaforandturtheragrees <br /> � � to remove same upon notice from the and to 2place public propeAy <br /> ,`/ � da re <br /> FI�:� IN pECT10N e � <br /> Hppmv=d as Constructed <br /> �/D-9'j <br /> Signature o+ Iicant Oate <br /> \ <br /> WORK AUTFIORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS IS UED AN�THEREAFfER�S TO BE DILIGENILY PURSUED TO <br /> COMPLEIION.THIS PER�AIT rv1AV BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 OAYS DURATION. <br />► <br />