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Date � � `� y <br />Applicalion For <br />PUBLIC WORKS <br />Print or Type Only <br />� <br />PERMIT <br />FEB 2 3 1994 <br />_ ._ ............. <br />CITY OF EVERETT. <br />Public Works Dept. <br />�'�1 r,v n1.E <br />City <br />Zip <br />�uGLc WoiFs Parmll � <br />iea.000�.+ — <br />P�bhcWo�ksFee $ <br />T0101 Fee <br />Less Pppl Feo Paid S <br />Balance O�e � <br />�� m� Ciry Zip Phone <br />Applicant Mailing Address <br />Describe Proposed Work =�S�n I� `��) S L F O� �,f (' � l-� fTT� �� u C�-1�C� �a• L' � <br />� I ✓� )(Li 5 iC��-lUil.� <br />� <br />Project Address (if known) �_��-' - -- -"- - <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Properly Lines • Centerline ot street <br />• Outline and dimensions ol all exisling and • Indicale Norih <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Exisling and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shall be made 24 hrs. in advance • ph e 259•8810. <br />2. All work ahall be performed fn accordance with this permit a current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. OL FREE NUMBER 1•500-424•5555. <br />/ <br />� <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />PUBLIC WORKS DEPARTME�JT <br />3200 Cedar Slreet <br />Everett, WA 90201 <br />Phane:259�8810 <br />ACKNOWLEDGEMENT OF CODIDITION:i <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold ��nd save harm- <br />less the City of Everett from any and all claims tor damages, costs, <br />ezpenses, or causes of action that may arise because� ol installation <br />and maintenance ol ihe improvement or olher righhof�way use hereto <br />applied for and (urther agrees to remove same upon notice Irom ihe <br />City and to replace public properly darnaged lhereby. <br />�C� • % 'Z c-C - • u�l % �% <br />Signature ol Ap icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO CONIPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />