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�" <br />TYPE OR PRINT ONLY <br />plicalion For <br />�UBLIC 1rvORK� PERMIT Date �-1Q-�� <br />PUBLIC WORKS DEPARTMENT Public Works Permit # ����r���'—� ��' <br />3200 Cedar Street <br />EveretL WA 98201 259-9810 Building Permit k -- - <br />'� � P 0 STI H G p'UG n 7 199r public lVorks Fee S �'�� <br />��, �<G �:�::,�.:����d . , �la�;'�/ 7"�?—G9� � <br />,ici:. 5}:an}c 415 L�Le.vticc. i ., . � <br />Owner Mailing Address City Zip Phone <br />�i.;;c i' <br />Applicant Malling Address City Zip Phone r� <br />Describe Proposed Work r.r:, .,.u��utaccvr�ci h���:� <br />PROJECT Ai�DRESS (if known) <br />'� Attach four (4) copies of olans for proposed work - Draw to scale and note the following if applicat le: � / ���✓�/ <br />� •Property Lines •Outline and dimensions of all ezisting and proposed structures on the lot •Exisling and �Pos�d utllitiei'+� � <br />I� 'Centerllne of sireet •indicaie North •Show any pmposed grading changes •Show mea9ur�menis •� �,Q ) <br />I DO NOT WRITE BELOW THIS LINE e OF '�•.,' <br />PERMIT CONDITIONS: 4j'd�q., Eli�c' '• <br />1. All c211s for inspection shall be made 24 hours in advance - phone 259-8810." �i�j ABrT'•�• <br />� 2. All work shall be performed in accordance with this permit and cun �nt City of Everet���sign and <br />Construction Standards and Specifications. <br />, 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER i-800-424-5555. <br />,1 - i, l, <br />. L� .; .-�� i � � .,iC�, - _ � ;r' � %� l - ' ' C'l � � �� ! �^ F,; <br />:Gl%��I C ,;ii. . / <br />� (�W.lG✓ TU � ;X �Gi-kJ „�� �� �il�, �r GrY� G k � ' f r; r <br />�' <br />� i lC�G(J �7G'tJ�, <br />�, {��G%.� Ul0 (��ri�iC'Lf�cvi5 �{v f.���� ,,,il�l T'�;�: ��c;;:�:.�'.� . li <br />C ���� � I�f �J�('��� � 111i� ^� �'.�'i� �'lif5 �C���Gc� t'ci.���IC���C, i r�v�:7�- <br />� t��l-���cc� �� �',.-. r,iC� 7, �� I.'.��f <� �,i�;c;� rr�✓, <br />� <br />� <br />; ,_[L� .( 11 / �� C,L. 'i�//�//`/�! <br />Appiovetl tor struction Date ' <br />�'X�i`� ; -�- _ /- 3 i�� <br />SPECTION Date <br />Approved as Constmcted <br />p <br />ACKNOWLEDGEMENT OF CONDITIONS I <br />The undersiqned ownor/appllcant hereby aorees to hold and save harmless I <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action thai may arise 6ecavse of instailation and malntenance ot I <br />theimprovementorolherri�ht-of-wayus. -•etoappliedforandfurtheragrees <br />to remove same upon notice from the City and to replace public property II <br />damaged thereby. <br />. , �,, — , ._ _ <br />Signalure oF Applicent Date <br />WOriK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFfER IS TO 9E DI�IGENTLY PURSUED TO <br />COMPLEfICN. THIS PERtd1T MAY BE CANCELLED 3Y THE CITY UPGN ANV STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURA1 �CN. <br />