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Applica�ion For �����J O / <br /> PUBLIC WORKS P�RMIT Date.______'���'_'7"_O <br /> � PUBLIC WORKS DEPARTMf:NT Public Works Pertnit# D..3 S <br /> 3200 Cedar Streel � <br /> Everett,WA 99201 259-8810 Building Permit N <br /> b0 <br /> TYPE OR PRINT ONLY Public Works Fee$ �� — ��- <br /> ��UG��tI/y �FS /�2�I��CO ZZ Z 6 ✓�'/rSr3r�'J/� �v• /�"8Zd3 2�/'D ' 67;2.7 �raaLt.� <br /> Owner Mailing Address City Zip Phone <br /> /��-,��z ��o�y�- �ew��;so�s: �� �za s ,3J�J3�� <br /> Applicant Mailing Address Cdy Zip Phone <br /> Describe Proposed Work y�'4����� - W <br /> --- - � <br /> � <br /> PROJECT ADDREuS(if known) _�2'a� ���� U� S� � <br /> Attach tour(4)copies of plans for pmposed work-Draw to scale and note iho following i(applicable: � <br /> •Property Lines 'Outline and dimensions ot all existing and proposed structures on the bt •Existing and proposed utilities O <br /> •Centerline ci strer.t •Indicate North •Show any proposed grading changes •Show measurements � <br /> �� DO NOT WRITE BELOW THIS LINE <br /> PERMIT COIJDITIONS: Z <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. Y <br /> 2. All wor;<sha!I be performed in accordance with this permit and current City of Everett Design and v <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> d �.�,�7 r / �2 13-9 °.12AM V♦ <br /> J i ��7." Cc 7-y Sf✓C��S C�ea h a� 4 �� ��{m¢.� 9B035 0 <br /> � OTHER 2G.OG <br /> ! r :�D7AL �G.UO <br /> � CChy ��.-��' /i7S7�«Cd Lt�/7�/l/n � Q� .A OP14417 �'�-IEi: c , G <br /> /S.�.W' /vrUS� �c? /�1��/ev ��/�'L' CD✓C�i^;h� , � <br /> � , �Dr,�' S'�!a« ho7� C/e d hz So a S Z�a <br /> /f��4 C7� 7l-,C Sc�'rrovrKr�n� �Ot��er fieS . <br /> '— � ACKNClWLEDGEMENT OF GONDITIONS <br /> J ��i/����C ' The unde�signed owner/applicant hereby ac�rees to hold antl save hartnless <br /> ihe City of Everett from any and all claims for damages,cosis,expenses,or <br /> A roved f nst cti/• -� .�,� causes of action that may arise becaus�of installation and maintenance of <br /> i' ` theimprovementorotherri9ht-of-wayuseheretoappliedforandtudheragrees <br /> / �� -/� ��� , to remove same upon notice fmm the City and to replace public property <br /> ? � _/��1� �,� /�, y3_S� damagedthereby. <br /> f-� � <br /> FINAL INSPECTION Date <br /> Approved as Consiructed <br /> � <br /> i��nature of Applicant Date <br /> WORK AUTHORIZED BY TH!S PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION,THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />