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r� <br />� APFIicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />. � 3200 Cedar Street <br />' Everett, WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY <br />- �, Lti <br />Owner <br />J �YY1 'e <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />- S�o � FL. <br />Mailing Address Ciry � <br />� v ✓,un4-nin C ✓ <br />Mailin� <br />Date J J/�_"� /` � <br />Public Works Permit # I ' ��� <br />Building Permit k <br />Public Works Fee 3 �`� <br />y�,�� 9�a7S .363 - �OU �i <br />Zip Phone <br />A,.� 2!,"�,"_ 4'7!/ <br />N 9916� <br />OTHER 40.00 <br />TOTAL 40.00 <br />Attach four (4) copies plans lor pmposed work - Draw to scale and note Ihe following il applicable: <br />• Propeny Lines • Outline antl dimensions of all existing and proposed s�rucW res on the lot • Existing and proposed utilities <br />• Centetline of s�reet •!ndicate North • Show any proposed gratling changes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspectior� shall be made 24 hours in advance - phone (425) 257-881 C <br />2. All work shall be pertormed in accordance with lhis permit and current City of Everett Design and <br />Construction Standards and Specifications. , <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />r <br />�}. al=evv� l-����i,e� -�0 3 ,� ,,��e�;.cE.•l,Z,e1c zr-ca - C�,�� �e <br />' h���• v�� . <br />C 1,7 <br />W <br />� <br />� <br />V♦ <br />O <br />� <br />Z <br />� <br />'. �GNGG � � � ��C �OC�{� � rH , n � mVM O-� I Z� l�, a k �iv,.h �,�lc�e o% `_ <br />I%�✓✓(irV�'1'� �/� �e,f'�1^ -K/� �• ' 1'OuL� �Gi9CG �G!�rriG� �!�✓� fZk--�vcl�'n�'c`i <br />i <br />v� SE c��na� o ����. <br />(r. �-�xe G,�M;-Le�� fv 4G" he;yl�t <br />�o✓ tCIP.L� � r`�T,� �-� �3�le��y. <br />- �d�� �l �..s-/ � e,r�a; N ,•�i %o�kcd <br />�,( ,� ��.✓ %Ma/ <br />, ACKNOWLEDGEMENT Of CONDITIONS <br />' h� The undersigned owner/applicant hereby agrees �o hold and save harmless <br />�/ �d �� yr'f the City of Everetl Irom any and all claims lor dareages, cosls, ezpenses, or <br />pprove or ons ruc ion a e causes of aclion that may arise because ot installation and maintenance ol the <br />improvement or other ri�hbo4way usc hereto applied lor end turther agrees to <br />remo �e s�ine u n noti,e im�Cily and to replace public properry dam- <br />FINAL INSPF� �T'^": Date �/`� � ,! / � F <br />age reby. ��j i <br />Approve�..sCa._fructed ��i! !� /" 1 i���7i i � l/�3�L <br />igna ure o PP� � / ate� <br />WOFK AU11�10RI7FD BY hilS PF:RIdR MUST BE STAHTED WIhiIN 1� DAYS OF DA7E PERMR IS ISSUED AND THEREAF7ER IS TO BE DILIGENiLY PURSUE7 TO <br />C01,�pLET10tJ. THIS PEr1MfT MAY� BE C.4NCELLEO BY THE CfTY UPON ANY STC�PPAGE OF WORK ON THIS PRQIECTOVER 90 D/1YS DURATION. <br />