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(} , S <br /> Date 6///(J �)''. j Public Works Permit# c51CV•2=^7 6 <br /> r <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS .PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due .$ -` <br /> i Owner Mailing Address City Zip Phone <br /> f A -- i T P E. f#. ' 4 r;.7)Nt '':.1-'. a._�3-.. i P C' c ,}t �, _t,;' -1 ! �,-s`l tl s ,' p ` '- <br /> �1 ,� ! tom. ' �3'-=a �.f4 t *f.. - <br /> Applicant Mailing Address City Zip Phone <br /> ! ? d <br /> Describe Proposed Work 1 ) . : .. - _ 1, °7) -. ik .,,:,Cam. / 1 t c / t c. c.t ti„ I d t Ae -„ <br /> G: :'c tiS' .— I /i:`' a l.G y he, i ..s't' lel-it.1 e'4 "` 7', R.? 1- .L' r `)f% -i ..;,- r - <br /> ddrr ( W <br /> Project Address(if known) tcac, C ,-� "t s• )`- t.Y"1IMM <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North Cn <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CCI <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction 1-3 <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> - Z <br /> ,"4 .A/44(/ - ✓ 40, Cc,vd T:=C+ ‘. `7--. 1, <br /> r O <br /> ll_ r- . '/7 f, n, L-,7' / .'64::/c'° .:ri'?,,e/.1":.S. <br /> IIIIMI <br /> RI r p <br /> Cn <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> - 9. / and maintenance of the improvement or other right-of-way use hereto <br /> �- '' ' �� t -� ' .0,- ` -; ` applied for and further agrees to remove same upon notice from the <br /> Approved for Construction 7 Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date --, ."t_. ` , ` :. -,° d: •i z::xy r f c.` `', je <br /> Approved as Constructed Signature of Applicant ' i J Date' <br /> l WORK AUTHORIZED\BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> e 320 Ever Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> J Phone: 259 8815 PROJECT OVER 90 DAYS DURATION. <br />