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ApplicationFor <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 259-8810 AW 0 2 <br />TYPE OR PRINT ONLY TO POSTING <br />I) I001-ji I $usira-ss gisowre-s to.P., A�O to 3 M4,tK. <br />Owner ling City <br />IelnFala�, %r��- ;yc< iyp-t% IVF S; ,,,.k <br />}-F"scam Mailing Address City <br />ourWKaora-) to ,� <br />Describe Proposed Work rowews %X;W- 6;, Ar 7drl L✓f LL <br />PROJECT ADDRESS (if known) <br />Date 1 �Zi4fi / <br />Public Works Permit 1r 9& SC- 1411 <br />Building Permit <br />Public Works Fee $-�� 8K <br />W Uf wslq ('12SJ42S 1I;3 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following If applicable: <br />'Property, Lines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities <br />'Centerline of street •Indicate North 'Show any proposed grading changes 'Snow measurements <br />W <br />to <br />ca <br />O <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 performed 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 1-800-424-5556. <br />4. Thar pro, jeof sbouGo� compGy wig the n`Ct#ys...; <br />d f re vinzr•,e.,,�s OW <br />.TIT uS><ri.FC Pre-freafn�en � --rTr, 3s O <br />reyatidr fo de-wa�eri.+ Sife. See Gent $e....otf' <br />W,,W IPT- f l OM°ol, <br />5, Gllork fa GOn� �I[r�Lan defeo� /r/��B <br />tic, �ee� cify SV-*"ee7s c'C�n of 4CC fiines <br />7 C2�rii 6as%ns spa lC ijavCs Trap �hr cit� spa., o!9�0 <br />/9CG./ �/ o�o3a.o! addi Eosin S,4a L! Conn ce fi. fo <br />Sills-Sac✓er i� Q More .s`1f�a. 'lot-fro�✓nrar/ ma nner <br />l'ofthcr 7644, n cohneC><ih u _yntoE qS -Mog Jm . <br />ME ITT <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, coats, expenses, or <br />roved for nstructio Date causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way, use hereto applied forand further epees <br />/ to remove same upon notice from the City and to replace pubic property <br />o o ;re <br />FINAL INSPECTION Date <br />Approved as Constructed <br />mike <br />o ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />