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� <br />TYPE OR PRINT ONLY <br />S y���� � <br />Owner <br />r.� //�s � <br />Applirant <br />Describe Proposed Work <br />Applicalion For <br />PUBLIC WORKS PE��IIIIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 (42�5�25�7-$P QQDD 1 <br />To PosTir��J �aN = 4 � <br />PROJECT ADDRESS (if known) <br />4� Mailing Address <br />,5 8,? s <br />Mailing Address <br />s � <br />!�e G, �� <br />RUI ,L <br />��,�e 8 �3 / .3 , \ <br />—�-, —�-- <br />Public VJorks Permit N 77/ c� <br />/ <br />Building Permit N <br />Public Works Fee S �� �� <br />f�y/'- / B,� <br />VT�'�", �/ <br />Zip Phone <br />SAO`a�j• �� <br />rnone <br />Attach four (4) copies plans br proposed work - Uraw lo scale and note the following il applicable: <br />• Pmperty Lines • Outline and dimensions ol aV ezisting and proposed stmctures on the lot • Eaisting and proposed utilities <br />• Centerline of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIOtJS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257•8810 <br />2. All work shall be per(ormed in accordance with this permit and current City of Everelt Design and <br />Construction Standards and Specifications. <br />3. Call Loc :ion Undergrour.d Service 48 hrs. beTore you dig. TOLL FREE NUMBER 1-E00-424-5555. <br />� /��eP Wa, �L� O�2 Cr� '{�ror.'i �iS�i � CUr6 Q fr� � n i m Ui+-i df <br />� f� �,- {'�t�� s:d¢ w�L� <br />` <br />�, <br />r <br />3 � o`S-6�� /Y2r <br />W <br />LJ. � <br />� <br />V / <br />— � <br />�� <br />� <br />. � <br />0 <br />(,.(J4(� RCOM� Q��Ky /S c� /�C ^CO�S��hUcfiOh U7' eX�ST/n! <br />L L ` � <br />��UGC LV2�� O�+'f S7'i[( i'e%�U//'CS CL �iii��i%�✓ P2rl�ni f, <br />Ll�� l:7a�n�aine��CL' I'��v,re�an -1�/,�s �clalL �!'/�uLl � ffiC <br />�'ffP on c,G� �.�/ oF t6e Pro��¢�fji ac�/ner, <br />Z'{' �/ie e�fy eve r r�e�ps �fb us� 7<h.s �P�i� f a�=wr,,t/ �.he <br />/,e�aLL Sh4LL /e r���oi��/a� �1,c ocvne.-,s �.��c�nge, <br />P�� frcf�;'c. lc Sr§hf-d+sl��C<� <br />,r,� 8-// - 99 <br />pprove or , s mc iop ate <br />�`_� �a -,�-� <br />FINAL INSPECTION Dat� <br />Approved as Constmded <br />WORK AUTI-IORIZED BY iHIS PERMfT MUST BE STARIED WfTHIN 780 GAYS <br />COMPLEf10N. THIS PERMR MAY BE CANCEUFD BY iHE CRY UPON ANY f <br />/�� <br />V♦ <br />�N <br />I�ci� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant horeby agrees to hold and save harmless <br />the City o� Everett Irom any and all claims for damages, cosis, expenses, or <br />causes of action thal may anse because of installaGon and maintenance of the <br />improvemen� oi other right-ol-way uso hereto applied for and further a�rees to <br />remove same upon notice Imm the City and ro replace public property dam- <br />vif ISIS.iUEDANDTHEREAFTERISTOBEDILIGEMLYPURSUEDTO <br />WORK ON T1iIS PRQIECTOVER 90 DAYS DURATION. <br />