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� APPlication For �� � / <br /> PUBLIC WORKS PERMIT Date <br /> PUBLIC WORKS DEPARTMENT Public Works Permil M _� � <br /> 3200 Cedar Sireet <br /> Everett,WA98207 259-BB70 <br /> Building Pertnit N <br /> TYPE OR PRINT ONLY Public Works fee S Z� — <br /> ��� � � � <br /> +'IC O�e l/L ���7 MalZg Aaa�/� �eo%I/ �II��HH(v�cv�� z�P�Zt9( Pno 3a3— 9�5 <br /> 5iv✓�� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work_C�tw:�nc �'rv� � 5/Yt4 /�.�5 _ � <br /> , <br /> � <br /> V♦ <br /> PROJECT ADDRESS(if known) Z�G� /f�-K �. � <br /> Attach four(4)copies of plans for proposed work-Draw 10 scale and note th.�following if applicable: O <br /> •Property Lines 'Outline and dimensions of all existing and proposecl structures on the lot •Existing and proposed utilities <br /> •Centertine of street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> t. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be performed in accordance with this 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 /> �}. l�a noi- G(��r closer -�-hc�v� ZS � �o -:r�pof � <br /> , <br /> B�� k �,�. -�,.�. �5�. s�,��r� o-� ��,� . a <br /> �� � �►� l � s� I � -�cnce �cs ��„� S-�d PI n # ZoSi� �3_ <br /> IvtS��l Z�,t�� I eras� cah �4Yo I r'�¢�ts�rts t�+ -!'�e, <br /> 04/23/97 4:09PM OOORM0937 kk:k'k <br /> �irtc+<o� �� -�-ke �,bli-� l�b✓�s ;1� s pec-4o% � <br /> x0004�izn <br /> � ke� �.;� S��5 G l ezc H �c�{- a 11 -f��m-e�t �s.00 <br /> ` �H�c�c s2s.00 <br /> �� L�S � �p/a4 S�� �r:�C� c�/�'�r ,3 ,�✓wr,� <br /> 1 <br /> ACKNOWLEDGEMENT OF CONDI110NS <br /> 3 � The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � the City of Everett(rom any and all claims for damages,costs,ezpenses,or <br /> Approved or Con iCNo . , Date causes of action that may arise because of installation and maintenance of <br /> .���� the improvement or other nght-of-way use heieto applied for and turther agrees <br /> ! �;" ' to 2move same upon notice trom the City and to replace public pmpeAy <br /> �' �:-�_-- � _ �- � damaged thereby. <br /> FI AL NSPECTION ! l � Date <br /> Approved as 6dnstructed <br /> re of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENRY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CI7V UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS DURATION. <br />