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/� � <br /> �J APPhWtionFor V��4/qC/ . - <br /> PUBLIC WORKS PERMIT °��e _ �J �7� <br /> PUBLIC WORKS DEPARTMENT Public Works PermA z ={V/lf�� <br /> 3200 Ceda�Street � <br /> Everett,WA 90201 259-8870 Building Permit k <br /> �/�so <br /> TYPEORPRINTONLY f���L'�:"rc��oc�7 PublicNbrksPeeS=�`�� <br /> , —��%S e� <br /> �=vt�E7F���.ci�y �24cT� �1Z2S-/�Y% E..Ei�i% 482v3 Z.f'�'- T� : ) <br /> Owner Mailing Address City Zip Phone <br /> SA r�E <br /> Applicant Meiling Address City 2ip Phone I <br /> Describe Proposed Work co,v s i'��c j A �n i7't u�y Zv �r�(�to� �E . . ■ <br /> W <br /> '�'t �-rz.lt.i.,c— /�z�/� . � <br /> � <br /> V♦ <br /> PROJECT ADDRESS(ii known) �/2/� C��-i 1 `1 � <br /> Attach four(d)copies of plans for proposed work-Draw to scale and note the lollowing il applicable: O <br /> •Property Lines •Outline and dimensions of all existing and proposed stmcWres on the lot •Existing and proposed utildies <br /> •CeMedine ol slreet •6idicate Nonh •Show any proposed grading changes •Show measumments � <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 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 t-800-424-5555. � <br /> �, Fi� �W ��.�'DUC� �/! ahrt! G�A{.Ccl 8�Z/y$ � <br /> O <br /> �i . <br /> a <br /> SEWcF <br /> T��.�, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appGcant hereby agrees to hold and save hartnless <br /> � � � �he Cily of Everett irom any and all claims lor damages,costs,eapenses,or <br /> �oved 1 - ru„lion at causes of aclion that may arise because of installation and maintenance of <br /> the impmvemenl or other righFof-way use herero applied for and furiher agrees <br /> L� / � to remove same upon notice from the City and to replace public property <br /> ,. ;� .� �i—�� � damaged therr.by. <br /> FIN INSPECTION � Date <br /> Approved as ConslmctM 1 _ ,�, /,' <br /> (/' • . ` 'Y-!�/ v .c. $.✓o-`� <br /> igna u � f Applicant Date <br /> WORK AUTHORIZED 8Y TH�S PERMIT MUST BE STARTED 1N17HIN 1B0 DAYS OF DATE PER IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY DE CANCELLEO�Y THE CIN UPON ANY STOPPAGG OF 1VORK ON THIS PFOJECT OVEfl 90 DAYS DURATION. <br />