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ApPbcabon For � <br /> � <br /> PUBUC WORKS PERMIT Date._�� � <br /> PUBLIC WORKS DEPARTMENT Public Work,Pertnit X /��i <br /> 3200 Cedar Street —� <br /> Evereu,WA 98201 259-8810 <br /> TD POSTING MAY 4 � �ssa BuildingPermitk <br /> TYPE OR PRINT ONLY Public Works fee S GtJ� <br /> _f�i�K /n��ri �� �31bL Rac,l�ller Ev�r�.Z} w� 9gZo� s�z.s ys-q yq7 <br /> Owner Mailing Adtlress C�� � <br /> Y ZiP Phone <br /> �a I�e_ M i }��� ll �/`'!/9 /N, �/;ew ,�r' F�„��Nk98Zo3 5'LS zfz SGY9 <br /> Apphcant Mai6ng Address <br /> GtY ZiP PAone <br /> Describe Proposed Work� ry[[e5 S /7j���j hS (� .� (y 5 � S T Be <br /> ��.wl� !+' Fr . A SO A.ti(/ ��IC1� f! bG UUIr�% � <br /> w ; �-1, A la �-- �' <br /> PROJECT ADDRESS(iF known) ��C0� ��Q. E��- W�1 q$Z!'i � � <br /> Atlach four(4)copies of plans for pmposed work-Drew to scale and oote the following if appliwble: m <br /> 'Property Liries 'Outline and dimensions of all exisling and proposed structures on the lot •Existing and proposed utilities O <br /> •Centerline ol street •Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDI710NS: � <br /> 1.All calls for inspection shall be made 24 f;ours in advance-phone 259-8810. <br /> 2. All work shall be pertormed in accordance with this permi!and current City of Everett Design and O <br /> Construction Standards and Specitications. <br /> 3. Call Location U;iderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> y -SiSz=�i ��cTz.J �i;�.e�/�2�� ���� �' <br /> � <br /> T� �< «y O <br /> a <br />� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> � �� the City ol Everett from 2ny and all claims for damages,cosfs,expenses,or <br /> Ap�ro or ConsJruytio� - pa1e causes of action ihat may arise because of installation and maintenance oi <br /> f/ ihe improvemenl or other righl-o4way use hereto applieG for and further agrees <br /> � to remove same upon notice fmm the City and to replace public property <br /> � �•� J ' J' 's� damaged thereby. <br /> FINAL INSPECTION • Date ` ,n <br /> Approved as Consiruded p"/� /�� `// <br /> / `- � �/�� / <br /> �//�t <br /> S nature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN 180 DAYS OF DAIE P'cRM1T IS ISSUEO AND THER!-i1FTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE Of WORK ON THIS PfiOJECT OVEFi 9G DAYS DUFiATION. <br />