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�\4 � /_� <br /> `/ APPIiWtion For <br /> PUBLIC WORK� PERMIT � °a'8_ � — r � "� <br /> PUBLIC'NORKS DEFAF i MENT blic Works Pertnit R �' <br /> 3200 Cedar Stre�.i n � <br /> Everett,WA 98201 259-8810 n Building Permit��/00� <br /> . � <br /> n� <br /> TYPE OR PRINT ONLY Public Warks Fee$ �� <br /> J'o� S�p�z�a�-Y Z.�63n S��`` �*�E_ GJ�'�S `YrJ.Uwo�d ?�f4=E3�'� <br /> Owner � Mailing Address City Zip Phone <br /> �5��1'�C� <br /> Appliwnt Mailing Address ` ity Zip Phone <br /> DescribeProposedWork �Uc.��f C dL��n1C.��<<T� Cc�.i-2�y o " <br /> L11 1 �ir <br /> �� 64c1—{toe Or'1�v fJrOOCrT� �o pl� �¢ST �dlQS , � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) �6 � S E.V L ,J p ,�-✓��2�' ( � <br /> Attach tour(4)copies of plans lor proposed work-Draw to scate and note the following it applicable: <br /> � t�Q.(� �Si�N OOOart396 ` ` <br /> �Property Unes 'Outline and dimensions of all existing and proposed structures on the lot •Existing and p��pes dP�iliti�s <br /> 'Centerline of sireel 'Indicate North 'Show any propased grading changes •Show measuremenls ��00950Q6 ' <br /> DO NOT WRITE BELOW THIS LINE � c � ° <br /> PERMITCONDITIONS: CHECF; #�O.DD � <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 1-800-424-5555. H <br /> T, �rc-v�.� tc�-.�y �osco� .•Cos,fv�o� as v� <br /> O'l�cC�c d �y�7<<ic G/TY �uSL�G [,vo�,f's 2j�sP�cfo�-- O <br /> � a <br /> ..�, ,�'ciep S� . <br /> �ez�fs C �¢ah <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees ro hold and save harmless <br /> � /���� ///�� the City of Everetl from any and all claims lor damages,costs,expenses,or <br /> •��-' causes of action that may arise because of installation and maintenance ot <br /> Approvedf r onstryction Date theimprovementorotherrighFof-wayusnheretoappliedforandiurtheragrees <br /> � � /� to remove same upon notice from the City and to replace public property <br /> � ` �, damaged ihereby. <br /> FINAL SPEC"fION Date � <br /> Approved as Constructed n„/ /1 _ , � <br /> � �y-�.O�f�'�NC <br /> . Signature pplicant �J Date <br /> WORK AUTHORI2ED BY THIS PERMII"MUST BE STARTED WITHIN 1B0 DAYS OI"DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILICEN7LY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PRCJECT OVER 90 D.1YS DURATION. <br />