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� APPlication For � <br /> PUBUC WORKS PERMIT °a1e—G� <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# /�� �)��� <br /> 3200 Cedar Street <br /> Everatt,WP.98201 259-8810 Building Permit N <br /> TYPE OR PRINT ONLY Public Works Fee$_/�.� � <br /> �� C . So�Prblem <br /> Owner Mailing Address City Zip Phone <br /> �fITR !C � BDUJE�1 6//S C�Mf�r/o� �'✓P��7J� 9�.?03 3��_ o7/O <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work n Pi�✓C F, h 1��4r O � P�o ,n P� I Y fo B�oa 4u/4�_ � <br /> N�Pd �.Ul7 S� o4 ��P/' U/��//%i7o ~ S/9n /1�P�c /-O � <br /> � <br /> _ � F I�Phsn(/�' � ,�/� <br /> ♦/♦ <br /> PROJECT ADDRESS(if known) 6�/.S— CD/J»f P/`[�jq� _ � <br /> Attach four(4)coaies oi plans for proposed work-Draw to scale and note the following it applicable: O <br /> •PropeAy Lines 'Outline and dimensions of all existing and proposed structures on tY�e lot •Existing and proposed utilities <br /> 'Centerline ot street •Indicate NoAh •Show any preposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIOIJS: � <br /> 1.All calls for irspection shall be made 24 hours in advance- phone 259-8810. � <br /> 2.All work shall t�e performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location L^n�!c:nround��rvice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> 'T, C�/ /��Ji ��/rGT!�� - V♦ <br /> � <br /> a <br /> ��'�9�`96 4:30F'H a00At#4'c� " '' <br /> / <br /> #000950'a7 <br /> DF.IVW;� 3�O.OD ' <br /> CRSH 2^0.00 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> - �//� The undersigned ownerlapplicant hereby agrees to hold and save hannl�ss <br /> � � v � C the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for Construction Date� causes of action that may anse because of installation and maintenance ot <br /> lhe imprcvement or other rigM-of-way use hereto applied for and fuAher agrees <br /> � to remove same upon notice from the City and to replace public property <br /> ��/��--- � ,��_y� damagedthereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructnd � � .- <br /> � �e-���e�, <br /> Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W17HIN 180 DA`.'S OF DATE PERMIT IS ISSUEU AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY DE CANCELLED BY THE CIN UP�N ANY STOPPAGE OF WORK ON THIS PROJECT OVFR 90 DAYS DURATION. <br />