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� <br />TYPE OR PRINT ONLY <br />�r� n,7� � �s <br />Appl¢ntion Fo• <br />PUBLIC WORKS PERMIT <br />� <br />PUBUC WORI<S DEPARTMENT <br />3200 Ceoar Stree� <br />Everett, WA 88207 259-8870 <br />Date /a- Z Z- j� b <br />Public Works Permit p 96 '¢/O <br />Building Permit M <br />, �' ��, <br />Public Works Fee S �� <br />��, <br />�3or�/yf F�•,,t�uk. 9Y�oi .zs.z- �i��9 <br />cJ � /'r1 � <br />Applicant Mailinp Addrsss <br />Describe Proposed Work 01 S <br />PROJECT ADDRESS (if k�own) <br />Phone j <br />'c{ /PGC G <br />_�.�� —,S'.3�4�J� <br />Attach lour (4) copies of plans for proposed wurk - Draw to scale and nole the following it applicable: <br />•Propert� Lines 'Outline and dimenslons of all ezisting and proposed structures on the lot •Existing and proposeJ ut�lities <br />•Centedine of streel •Indlcate North •Show ae, preposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 i��urs in advance - phone 7.59-8810. <br />2. All work shall be performed in accordance v+ith this permit and current City of Everett Gesign and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEA 1-8U0-4245555. <br />� C(�o.�.F fv 6c d�e ns �x.- �� �/ie �.mlo.�, <br />�, <s ?� 1D��i'1Pr. �IOPHE:� <br />'tODi796410 <br />�::`V�EF b"�D.O(t <br />r'fi°'�' +"O.L� <br />� <br />O <br />rif,•c.E�`J a.: ovr.�u <br />ACKNOWLEDGEi,1ENT OF CONDITIONS <br />The undersigned ownei/applicant hereby agrees to hold and save hartnless <br />� � O /� 2 s, 6 ihe Ciry ol Everett from any and all claims br Oamages, costs, expenses, or <br />��y causes uf action thal may ariso beauso of installalion and maintenance of <br />App edforConsiru tion Date theimprovementorotherrigh�-ol-w�yuseheretoapNliedlorondluAheragrees <br />��� D /� L A— te remove same upon notice from ihe City and to replace public properry <br />��� � v damagetl thereby. <br />FI�A.L INSPEi. ON Date � <br />roved as Constructed ^ � l, <br />%PP .G _ �(/" � �i �. , G <br />ig ro ot AprAicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE Sl'ARTED WITIi!N 180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMFLE710N. THIS PERMIT MAY BE CANCELLED BY THE CITV UPON ANY STOPPAGE OF W9RK ON THIS PROJECT OVER 90 DAYS DURATIOiJ. <br />