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,4pplicabc�For A l /r1/Q/_ ' <br /> � PUBLIG WOF�FCS PERMIT Date � < <� �«, <br /> PUELIC WORKS DEPARTMENT Public Works Permit# C��`_ <br /> 3200 Cedar Slreet <br /> Everett,WQ 98POST!N GiO����N 1 5 �998 Building Permit#���_s�� <br /> N t8 _ <br /> TYPE OR PRINT ONLY Public Works Fee S � <br /> l�rle PIa�K �D I�oxZZ�� �ior� �8203 35�-4�z5 5l3-9D31�x <br /> O ner Mailing Address Ciry Zip Phone <br /> ( /W � -- <br /> Appiicant Mailing Address City Zip Phone <br /> Describe Proposed Work 1]�e>.1� ��l�p I�i�C � <br /> � <br /> � <br /> I q 33 1 �,�� �1� ��t t�� 07-30-?7 9:54RM � <br /> PROJECT ADDRESS(if known) 1"l�J j`•t T3 q 535t�1 �pp <br /> Attach fcur!4)copies of plans for proposed work-Draw to scale and note the following if applicable: BpUII'LOING IO4S.0� �`J <br /> •Property Lines •Outline and dimensions ot all existing and proposed sVuctures on ihe lo: •Existing ah¢D�A��+�s00 � <br /> •Centerline of street 'Indicate North •Show any proposed grading changes 'Show measuremen5� <br /> 120.00 � <br /> DO NOT WRITE BELON/THIS LINE • � <br /> PERMIT CONDITIONS: DRIVEb1AY 20.00 � <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-88$b. 9218 � <br /> 2.All worl<shall be performed in accordance with this permit and current City61@T6�ierett 06��J)Oand <br /> Construr,tion Standards and Specifications. H 30916 <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE N66�ER 1-8tlD34B&-5555. � <br /> UTILITY DEV � <br /> G� i�11-}� � ih.e. � rti �10�-� -�-0 5��e�� o2t so <br /> � � <br /> CHEK �0 <br /> ✓-�- P� dr U�� �-v d Yr.c--� r�v�o{� -f-o s-(r�,e- ..}� a <br /> �'lz�e �= 5 �1� of I�-. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby agrees to hold and save harmless <br /> th=City ot Everett fmm any and all claims for damages,costs,expenses,or <br /> —l` causes of action that may arise because of installation and maintenance of <br /> A roJedfor uction D e theimprovementorotherright-of-wayuseheretoappliedforandfuriheragrees <br /> ( � r to remove sa e upon notice:trom the City and to replace public propeAy <br /> ���' 3- 3"j� dam� t re y. <br /> i�iNALINSPECTION Date �/% y <br /> .4pproved as Constmcted � l U 'I <br /> ' n re ot Applicant a1e ' <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIl'HIN 180 UAYS OF DATE MIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY CE CANCELLED BY THE CITY UPON ANY STOPPA OF WORK ON THIS PROJECT OVER 90 DAYS DURlQION. <br /> �kt <br /> ' , �'���,\ <br /> 1 ��.. \Gct"`._I._�DS <br />