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Application for / <br /> PUBLIC WORKS PERMIT Date � � g6 _ <br /> PUBLIC WORKS DEPARTMENT O� �3� <br /> 32�8 Cedar Street Public Wo�ks Pertnit# /_ <br /> Everett,WA 98201 259-6870 <br /> Building Permit q <br /> TYPEORPRINrONLY Tp �pcJING �AN �� B 1997 Oo — <br /> � Public Werk>Fee$ ��i –� <br /> � /� f� � ��,• �2a� aK�7`/01'`8'S9'� <br /> Owner Mailing Address ����2 <br /> ` � Z�P Phone <br /> [J����� rc� /F,k .ZxJ�c.e�;�. �7Q %8'�8' 7'Yr,2 8'�92'1 <br /> Applicant Maihng Address <br /> / C�ty Z�p Pho e <br /> Describe Proposed Work �� 1 A � <br /> �S eQ�_� �U a ` <br /> �' ,,c- ' i,V <br /> �J o/� w � c,,,q � h� � <br /> � <br /> P90JECT ADDRESS(if kr�own) /' �C� � V♦ <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note th following if applicable: m <br /> 'Property Lines •Outline and dimension;of ali existing and proposed struc:ures on Ihe lot •Exisiing and pwposed utilities O <br /> •Centedine of street •Inuicate North •Show any proposed gratling changes •Show measuremenis <br /> DO NOT WRITE BELONI THIS LINE " � <br /> PERMIT CONDIT�ONS: <br /> 1. AII calls for inspection shall be made 24 hours in advance- phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and SpeciFications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> `� ��z ��z���1 s��,e , ~ <br /> � <br /> � <br /> a <br /> :l-`!]9,.'9� ^'r."' '��L�h"+�`:f'E � �}:::'f�.` <br /> / <br /> t;0009r.036 <br /> �,r�_; s:,o,^:� <br /> ru:c; _^n,co <br /> ACKNOWLEDGc"MENT OF CONDITIONS <br /> The undersic�ned owner/applicanl hereby agrees to hold anC save harmless <br /> � y� �J `f� the Ciry o(Everett from any and all claims for damages,costs,expenses,or <br /> Approvetl onst�ction � causes of action that may arise because of installation and maintenance o( <br /> J � / theimprovementorotherright-o(-wayuseheretoapplietlforandfutlheragrees <br /> _ /� ��y. � to remo e same upon notice from the City and tu replace p�iblic property <br /> �—�CT�O _ �. ,—�L�/ �'` dama d�her � <br /> Approved as Constmcted ���e / <br /> Sign�ture of Applicant —�—/� — <br /> WORK AUTHOaIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERf�41T IS IS.�,UED AND THEREAFTER IS TO BE DILIGENTLY PURSUEDaTO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DNYS DURA'�ION. <br />