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h � <br /> � . APDlication For �7 — <br /> - P�lB�i�C WORKS PERMlT Date � --� - 97 '" <br /> PUBLIC WORKS DEPARTMENT Public Woiks Permit It _ /� G�F'3 <br /> 3200 Cedar Sheet <br /> Everett,`.NA 98201 259-8870 Building Per�nit k � <br /> TYPE OR PRINT ONLY Public Works Fee S ��' Co <br /> BK Jc�C�� �-(itC�Os�/�� <br /> 5�1�/1-�{ON l�/t� ✓n so,�r 1 G 3G /7�u�F T- �=dCl7�/T ���Y � G�/ o`�,5� - / r1'�/ c���.�.� /-2/;�, <br /> Owner Mailing Address City 2ip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Dzscribe Proposed Work ��Sh> LC Q {.•cc ��� ��c Ci�� /�.a «-o�'-�itt� � � 1 <br /> iii <br /> -- � <br /> ��/� <br /> V♦ <br /> PROJECT ADDRESS(if known) ���O �� �°�G /�y'► <br /> Attach tour(4)copies of plans for propased work-Draw to scale and notu lhe following if applicable: `/♦�� <br /> •Property Unes •Outline a�d dimensions of all axisting and proposed struclures on ihe lot •Existing and proposed utilities V <br /> •Centerlir•.of street •Indicate North "Show any proposed gratling changes 'Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All cails tor inspection shall be made 24 hours in advance- phone 2::5-8810. . O <br /> 2. All work shall be performed in accordance with?his permit and current City of Evere:t Design and <br /> Construction Standards and Specitications. � > <br /> 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � ,�' /, -,. �'1� l 'o OC � � ii V♦ <br /> 7, / zi7CC �p � �Q.1�//7,u/ �Z L����'.� O <br /> �1 V <br /> 7/c ,2,/1;7�—a�- 'C�;�t.� �. <br /> .�'� �Gh.S-�/�,:./ nc�/^ �I/�/C/7�^ C/ �l�<'�C�/1 . <br /> ' X' <br /> 4CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneVapplicant hereby agrees to hold and save harmless <br /> , �^ �� /� 3 ,/qr Ihe City of Everetl from any�.�d all claims for damages,cosis,expenses,or <br /> e �� � causes of action thal may arise because ot installation and maintenance of <br /> Appmvedfor nstru ion �Re � theimprovementorotherright-oFwayuseheretoappliedforandfurtheragrees <br /> � to remove same upon notice from the City and to ieplace public pmperty <br /> ., � � ?�'��s, damaged thereby. <br /> tLl ✓ � <br /> FI INSPECTION Date C � �� � � <br /> Approved as Consiructed \ �iJ?i„vGC�%�'Y\ <br /> ature of A plicant Date <br /> WORK AUTHOF'ZED BY THIS Pt'7MIT MUST BE START[D WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY�E CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUR�TION. <br />