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� APPlication For / �� / — � � <br /> PUBLIC WORKS PERMIT Date <br /> PUBLIC WORKS DEPP�TMENT Public VJorks Permit# ��j�JJ <br /> 3200 Cedar She et �7 <br /> Everett,WA 98201 L59-8810 <br /> Building Permit# <br /> TYPE OR PRINT ONLY 00 <br /> Public Works Fee 5 �0-- <br /> _ �ckT�n�+ � L J'oHnJso�J (kj x llc� StiPrP l.k 9���� S�q zc/6 /OIZ <br /> Owner Mailing Address City Zip Phone <br /> ►C.� k f �dh �s�r� 926 /ZS %H !�C n, al �,,��,�ySu�GLLs 'f27/ 36U G,s2S3G5/ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �� c r+� o U� �c7� RT (=� � � f}r k� n <br /> Rces �n�� 2�7� , N w �z/-� Dcco�,¢z�� u� Z�7.4iN� n W <br /> (3I�LkS . /�Iso C.iY- �urb K}-�v� Ce.nenr �N !+ S/ o e ~ <br /> PROJECT ADDRESS(if known) _ � Z Z �{ � p� 6�/L(� A�� u:-?g.!q^ ' ;��M --+,^•ug== � :• <br /> F �Attach tour(4)copies ot plans for proposed work-Draw to scale and note ihe following if applicable: �o <br /> uooa97o.._ O <br /> •Property Lines •Outline and dimensions of all existing and proposed structures on the bt •Existing and pigp({�t1,Utilities,��.Y�� <br /> •Centerline o!street •Indicate Norih •Show any proposed grading changes •Show measurements „yEf i; $'_[',l� <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEi;MIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br /> 2.Ail work shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Cali Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> T, e�hS�z�� d�'�rie�-✓�� �es- �'%7�y �.SP`4:��4r� '�30% V♦ <br /> 5. �a<,�c ��� ah.e� t��G eor.a� oz qs�{,r,�.�e�a- � <br /> �P . PGIt�-�' Ccn;c� Z�c 6c: 2Uk'ZO� Gvr'{� Li�4 �•in Par,Fiiz,S � <br /> a�' o yC S frr`7� V <br /> � �—> ACKNOWLECGEMENT OF CONDITIONS <br /> � The undersigned ownedapplicant hereby agrees to hold and save harmless <br /> _� / �� ihe City of Everett from any and all claims(or damages,cosis,expenses,or <br /> roved ons io pa� causes o(action that may arise because of installation and maintenance of <br /> ,� the improvement or other right-of-way use hereto applied for and further agrces <br /> ��� to remove same upon notice 9rom the City and ro replace public property <br /> .r�'��� 3 /�-j�� damag reby. <br /> ' FINAL INSPE TION Date /���/ <br /> Approved as Constmcted /���� <br /> Signature�Apblicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERA4IT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUFA?ION. <br />