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� - ------ <br /> � PUBLIC WPORKS PERMIT � <br /> Date <br /> —i D����96 <br /> PUBLIC WOR�S DEPARTMENT /j/_�27 C <br /> 32�0�dar Street Fublic Works Permit p `Z((//J J <br /> Everett,WA 9�01 259-8810 � <br /> o Building Permit R <br /> TYPE OR PRINT ONLY � v�i � <br /> a �-y� <br /> � �i r•� Public Works Fee$ ZZ , ,>v <br /> �7 SG 31 .. � r'� <br /> m "' <br /> t'OMGI'D y -� �ue�yrc�� l�AY <br /> vwner ailing Address \� � � ���� -�/3 7 J�/ <br /> p Cdy Zip Phone <br /> Sia�i � ti <br /> �63� � � ¢ <br /> nPPhcant � ol5��d1„/ f,� L ✓c..'f�sJl— J�/3 ZdD I <br /> Madmqqddress <br /> �� Z'P Phone <br /> Describe Proposed Work � <br /> I-u c1'D — /Sp I or-ols Gj <br /> �' � � �,-.�s o �= rG✓�i � <br /> . �qGL. ��� � � 1 - <br /> �J �g t.-� .�. � <br /> PROJECTADDRESS(if known) Sio3 v� <«� � d <br /> �� <br /> Attach four(4)copies of plans for proposetl work-Draw to scale and note the follo�ving if applicable: m <br /> •Property Llnes 'putline and dimensions ot all existing and proposed structures on the lot • <br /> •Cen;erline of street •Indicate North •Show an Exisling and proposed utiliti?s O <br /> �� y proposed grading cF�anges •Show measureii�,ents <br /> DO NOT WRITE BEI_OW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspection shall be mad2 24 hours in advance- phone 259-gg�p, Z <br /> 2. All work shall be performed in accorctance with this��ermit and current City of Everett Design and <br /> Construction Standards and Specitications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-800-424-5555. <br /> NvT� , �6rL f/�aro-!� c�/ <' � <br /> �. K�-ro� , <br /> , `f'� (�'rov��c 2rof�r;� Gvn froJ �s c�,Yzc��� 6y �b/,z (•Gc�s-!ct' � <br /> /�s��- � <br /> � <br /> � C'omirz��G,:t/�-v6/,z c�f�.�u,�`?�r�t� ,`t ��✓/Jid � � <br /> �ti�'`�S — ar� G��,��i�r��/�(<<,� uhd��-r�-r�f ,'s �e���rrd <br /> �- �a��h� o�-�ti� �� . <br /> ��' <br /> C�����'��/ [ G, ACKNOWLEDGEMENTOFCONDITIONS <br /> l 7 l/' Th?undersigned owne�/applicant hereby agrees to hold and save harmless <br /> �(0 the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approvetl for Const ction Date causes of action that may aris=because of installalion and maintenance of <br /> � ihe Improvement or other righ4 o(-way use hereto applied'or and fudher agrees <br /> � - � to remove same upon notice (rom the City and to replace public pro�erty <br /> '��� �`�� l Z 2 57 damagedthere y. <br /> FI AL INSPECTION Date � <br /> APProved as Constructed <br /> � / <br /> Signatu�e of Applicant �1b � <br /> WORK AUTHORIZED 2Y THIS PERMIT MUST BE STARTE�WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUEDaTO <br /> COMPLEf101J.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />