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� _ � �► � APFlicntion For ' -� . . "' I <br /> , �� PUBLIC WORKS �ERNliiT �a1e ��° r� /' — I <br /> � PUBLIC WORKS DEPARTMENT Public Works Permit fl ` "' /I�J� I <br /> 3200 Cedar Street i <br /> I =Everet4 WA 98201 259-8010 <br /> Building Permit N <br /> TYPE OR PRINT ONLY Publi�Works Fee$ _ ' v /G <br /> '; _To r-rr .Dic�/.� �S E�/u,r wd.�, c=�=✓w+� So L o G 7Z 7/2.� I <br /> IOwner Maihng Address _ City Zip Phone <br /> IL /G.1 u,t r.�/�/1G� LnCGl1'.��� �.�J T�^C �J T- �d i+�ond A �GCZ.D 7 /I �"J TD�� i <br /> Apphcant Madmg Address City � Zip Phone <br /> � Describe Pro osed Work � ' /� � <br /> I P ��� o�,O/��JT C�m�� u��t�ina u.�, rr� <br /> - ' _P�C/S77iJ5 a:iF/o' i�q ,pc�lrvc � '� �V <br /> � � � c so�se � i7r4 E�/���o�. ,��-{ h <br /> Eda✓cz�� ulA, G�u2�, �i'�iv� c�'L� 7 �io4y '�9:� cu. yc�J. � I <br /> � PROJECT ADDRrSS(if known) � I <br /> ; — W <br /> � Attach tour(4)copies of plans for proposed work-Drew to sca�e and note the following if applicable: <br /> �, i •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existin9 and p;oposed utilities � <br /> - •Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> I PERMIT CONDITIONS: � <br /> i 1. All calls for inspe�tion shall be made 24 hours in advance- phone 259-8810. <br /> 2.All worl<shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction Ctandards and Specifications. <br /> � 3. Call Location Underground Service 48 hrs. before you dig. 'iOLL FREE NUMBER 1-800-424-5555. � <br /> � 'E, ��05'�oV1 Co�-tro I sh�� I l� i n st��I tr>�;i CX� l-1'� d��cc-�i�`�� ' <br /> O� -I��tC I�ul�l'� \�or�5 I�ls�:c:i��!' I <br /> I � I <br /> : a ' <br /> : . <br /> '' � � � �� <br /> ' � <br /> i MAY 1 �y 199E <br /> ...Ciry:,...., ... ... <br /> 1 �� auna°� p��RErr... <br /> � /,�/ ��siop i <br /> i � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � L The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � - s � . ���`/i/ the City of Everett from any a�Q all claims for damages,costs,expenses,or I <br /> �— causes of action that may art�e because of installation and maintenance of <br /> ; Appjn4edff on3tn tion Date theimprovementorotherright-of-wayuseheretoappliedforandfudherag�ees <br /> / � to remove same upon notice fmm the City and to replace public property I <br /> damaged thereby. <br /> I FINAL INSPECTION Date <br /> i ApprovedasConstructed �� � �� � ,--J � ��//_ I <br /> � �f� //C�/�� <br /> I SignaWreo(Applicant� , ' Date <br /> ' WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> �� COA1PLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF W09K ON THIS PROJECT OVcR 90 DAYS DURATION. ' <br /> I <br />