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ApplicationFor� �. � QSTING v��� � � ��"�� —_ —�- .. �� ' <br /> � PUBLIC WORKS PERMIT oa�e_ <br /> ��20/aG � <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit a �lY 23 ! <br /> 3200 Cedar Streel <br /> Everett,WA 98201 259-8810 Building Permit N �TZ <br /> 7YPE OR PRINT ONLY Public Works Fee 5_ <br /> Sk;� Ghupman �BoS W� levi p►• �vf Vtr�t c�3 3� �3�� <br /> Owner MailingAddress City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work � <br /> NeW Ix�c-hcd C-�2ird � <br /> PROJECTADDRESS ifknown � <br /> c ) �faloh <br /> . <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: 07/0:/96 �:2DFN p00qq65 ��k:�k <br /> •Property Lines 'Outline and dimensio�s of all existing and proposed structures on the lot •Existing and proposed.�tilities <br /> •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements ��005�072 <br /> DO NOT WRITE BELOW THIS LINE SRCHRG ^$4.50 � <br /> PERMITCONDITIONS: DRIVW�' 4�O,pp � <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. FLh� CH 5117.65 <br /> 2.All work shall be performed in acr.ordance with this permit and current City of�Desigr�'A� O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �. Slop� dr��GJ -I-a d�rcct t-v�o{'-�' away �m (n <br /> ad�acc►��- lo}s . � <br /> 5. T�t ��r�9e rtiof -FoP rvno-ff �h�►I be d�r�tc�.� a <br /> �I-o s�l�5h blcx� or -b �h a�P�d ►'h�����on <br /> -1-t"e.noh- <br /> (. Ca� � Pv b I Tc �lo�'lC� �v�s��ec,-kir G'� 339-�403 �r <br /> Pr�-�ohs�Fr�v�-l-ron rner:1-,�9 . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � �y�y,�f / pp The undersigned owner/applicant here6y agrees to hold and save harmless <br /> ,1� l C�� �!Z�`l..p the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved lor Cor�atruction Date causes ot action that may arise because of installation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> ��� to remove same upon notice from the City and to replace public property <br /> Cl� —-- �' 7 fG damag thereby. <br /> '-FINAL INSPECTION Date <br /> Approved as Cons�ructed <br /> 3 �6 <br /> Signat of App icanl Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PER T IS ISSUED AND THEREAFTER IS TO BE DILIGENiLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />