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�er,/�� APplication Fnr <br /> PUBLIC WO�RKS PERMIT °��° �`, G�� � <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit fl _ ��/I�L'�L' <br /> 3200 Cedar Street ��� <br /> qEverett,WA 9820' 259-8810 <br /> TO FC STI N G FEB 1 J ZO�2 Building Permit q 59102 <br /> 7YPE OR PRINT ONLY _ Public Works Fee$ � <br /> i <br /> Shd�un �1.va��� 112�� E I bber:��n' D�: ��rc�. \Ya �I�ZDS 4�5-743- t�5 � <br /> Owner Mailing Address City � ' - Zip Phone <br /> i <br /> Applicant Mailing Address ' � City' . Zip Phone <br /> DescribeProposedWork GarddP w� �� (1Vinc�SpdcG al�vG — nGwdr�vG�va " ! <br /> � iir <br /> _ � <br /> �/ <br /> PROJECTADDRESS(ifknown) _ I � ZZS G � B�C(ZSOfJ j)R, � <br /> Attach fom(4)copies of plans for proposad work-Draw to scale and note the followinq if applicable: <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on ihe lot •Exi_ting and proposed utilities O <br /> •Centerline of street •Indicate Norih •Show any proposed grading changes •SYiow measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITlONS: � i <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 253-8810. O <br /> 2.All work shall be performed in accordance with this permit and cur.ent City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Urderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> v/ <br /> O <br /> a � <br /> �, <br /> , <br /> � <br /> a <br /> 8 <br /> � <br /> i <br /> � <br /> G�-�r�l�` <br /> ,., ACKNOWLEDGEMENTOFCONDITIONS � <br /> / f � The undersigned owner/applicant hereby agrees to hold and save hannless i <br /> �/j f �� `�� U./ 1. ���- the Ciry ot Everett from any and all claims for damages�costs�expenses.or p <br /> i� <br /> Appmved for Construction Date �uses of action that may arise because of installation and maintenance of i <br /> / I Ihe improvement or other righbof-way use hereto applied(or and fuAher ac�rees <br /> � � -'/ /1A - �� to remove same upo tice from ihe City and to replace public property j <br /> ,� �ff� �,�,v-�� 8 -,�— damagedthereby. i <br /> FINAL INSPECTION Date '' gr L r S I <br /> Approved as Consiructed / <br /> Si n ure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7 ED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO BE DILIGENiLY PURSUED TO <br /> COMPLET70N.THIS PERMIT MAY BE CANCELLED BY THE CIiY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />