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� ! ` <br /> A{�icetlon For O ?O / \ <br /> � PUBLIC WORKS PERMIT Date �> 96 <br /> PUBLIC W KS DEPARTMENT Public Works PertnR M _�G �q <br /> 32 edar Street <br /> Everett,W 201 259-8810 Auilding Permit N <br /> TYPE OR PRINT ONLY g S '35p0 <br /> S Publlc Works Fee$ <br /> T��t� 6�� � • S2�(.17 �... s.W. BB v � 03 � <br /> Owner Mailing Addres�� � � � City Zip Phone L p�O e�_ <br /> r O "�� <br /> � — <br /> Applicant Mailing Addres City Zip Phone <br /> lescribe Proposed Work Onsf�vt 1�' S�'�a j�vz Lo rno n f o✓' V, Po�/�. � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) � b�2 J ��1 qTT � W . � <br /> Attach tour(4)copies of plans tor proposed work-Draw to sc�le and note the following it applicable: � <br /> •Property Lines 'Outline and dimensions of all exist�ng and proposed::tructures on the lot •Existing and proposed utilities O <br /> •Centerline oi street •Indicate North •Show any proposed grading changes '�how measurements � <br /> DO NOT WRITE BELOW'iHIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. AII work shall be performed in accordance with this permit and curront City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �' CE��S�aIG Iivr.�c�,ay �nf,-n„�� P�,- Crff/ V� <br /> �� .S'f4no�4rGl ��G7 � <br /> � a <br /> � �DL�int/- S�lLG f'c /^c�ohc.16C[ /Cor- Cos-�1����^ Gnf/ � <br /> �4iH•7�� ro leMs �� �y OcGlii- r-u/�r+ f�;r <br /> Lt/O/^�� Thk= 7/��i�Y�ra�.D h y-f7��''� /����StO� C L7p�24 rS <br /> tc �>s Qds���•«�e 6eSzd a� �f� /�rm4fion Prc✓.oeol <br /> �n, ..ZY� Sf�u�C �.' ��i2 oL�iqc�^ O� �e R,// f ar.fJ' � �erPetie.6i�i fy <br /> CG �'Od✓�r�4/C T�JG Us= Or�T�iG e4S¢n7Q/)f/ RCYGSS L✓/�/� \ <br /> IT�7c G[ur,�Y' �� �� eRse..,�_.,-�ProPcr'ff! ( /r�cl�J� f'�2 Lu�il�rServ;te ) <br /> i 7' / �/ /c d�f.oa! <br /> i 7 l�L�O/-rE �o �L u�I- 4PQinVfo� �¢h S d4�6a �".3-�'6 COP/ Q�t Cq�/� <br /> ACKNOWLEDGEMEIJT OF CONDITIONS <br /> The undersigned owner/applicant horeby agrees to hold and save harmless <br /> � '� y 3 � the City ot Everett from any and all claims for damages,costs,expenses,or <br /> Approve or Construction ate causes of action that may arise because ot installation and maintenance of <br /> e' the improvement or other righbof-way use hereto applied tor and turthe/agrees <br /> �-$���T �/���� to remove same upon notice from tho Ciry and to replace publlc property <br /> ��lDZ co�Pi.EzE�7 f(.�- Z-�-�f damagedthereby. <br /> FINAL INSPECTION Date <br /> _ y/�iy� <br /> natwe ot Applicant L ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE ST�HTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAV BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS WHATION. <br />