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� Application For <br /> � PUBLIC WORKS PERMIT Date ��� �;� <br /> PUBLIC WORKS DEPARTMENT v'� �— <br /> 3200 Cedar Street Public Works Pertnit p � I� <br /> Everett,Wqg8201 259-8870 <br /> Building Permit# <br /> TYPE OR PRINT ONLY N �G <br /> Public Works Fee$_ <br /> `C)!?'1 �,lG�ir ...'��� L`�' t�.,s! �i1 �C'ZD �%� 7l�,� <br /> Owner MailingAddress ��u� � � <br /> CitY Zip Phcne <br /> �/rntu�r-�/��)c:� Lcr...!/Y �ilt 73� f��1 T�. � �.nc i,,///i� �1 <br /> Applicant Mailing Address �-e 9F'��� ? 7� —'S T�S <br /> City Zip Phone <br /> Describe Proposed Work � �+` o ic �,;-�� �i� C� '�,�� � ��� <br /> P�C/_f�n�• �i/cfi-��. v;./urc Z-` r�' �'.4Ci(%1� � � <br /> c✓ /". ��c%�-r oc�� <br /> �G � / � <br /> �t/"✓��-L uJf� �,;lQy :'7��iciJ .L1Z�. �rJ n�?c�,,( v � <br /> � 4�v c�, �,Gs. � <br /> PROJECT ADDRESS (if known) <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if appiicable: m <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities O <br /> •Centerline of st2et •Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. � <br /> 2. All work shail be pertormed in accordance with this permit and current City of Everett Design and 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 /> `�-, �"os�ov� C,�v,fro� sha� l � instal�ed Af �h2d;�c-f-�rJ� ~ <br /> of -I��e Publ�G YJnr�s Ins�.-fo�' � <br /> � <br /> a <br /> ��� � <br /> �Qrl � � D <br /> 19g � <br /> ���.�........... 6 <br /> Qvil��F FVF�"�••..... <br /> � D/�;5�nTT <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> -� � the City of Everett(rom any and all claims lor damages,costs,expenses,or <br /> Ap ed fo ons ion �,� causes ol action that may arise because of installation and maintenance ot <br /> J' the improvement or other right-of•way use he2to applied for and fuAher a9rees <br /> � / to remove same upon notice trom the City and to replace pub�ic property <br /> �' l�� damaged thereby. <br /> ruvAL INSPECTION D �e <br /> Approved as Constructed ^ � <br /> / <br /> � � �r.:.--..�, ��/� <br /> S�gnature of Apphcant / —Tate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />