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� . . . .. . . . . . . ' _ "�. . <br /> �' . _ <br /> Appliwtion�For � � � /�+� � �� <br /> � PUBLIC WORKS PERMIT Date : <br /> ' �r� /i 4� ,' <br /> I PUBLIC WORKS DEPARTMENT Public Works Pertnit M <br /> I 3200 Cedar Street <br /> Everett,Wq98201 259-BB70 � I <br /> Bullding Permit# i <br /> IYPE OR PRINT ONLY Public Works Fee$�3� II <br /> 7oHri 3E,� 02 0 3 E G-�1� F���TT" 5���� � S S� 3/� a- � <br /> Owner Mailing Address City Zip Phone(j�7�ys ��a.•/q7`� <br /> �La� Uw-+ i <br /> Applicant Mailing Address Ciry 2ip Phone I <br /> I I <br /> Describe Proposed Work PLfIC E SO To /Sv y/b'OS uf- D�R I O/1 !-//�L � i <br /> SL�P�n(r ib l-Jl.�f2 PFlrZi oG (='coP�� r7 -FoCi F�7�i-E � <br /> ��ZI✓E (.y7cKL.iA-i� sln-i�nV �.v.-. sHa-' o.. L.:w/`z C•�u,,� N^ � IZva'� i—c�.:� /oo � c�-�fu _ I <br /> G � � I <br /> PROJECT ADDRESS(if known) � i <br /> Atlach four(4)copies ot plans for proposed work-D�aw to scale and note the following if epplicable: O I <br /> 'Property LJnes 'Outllne and dimensions oi a�l existing and p�oposed stru::tures on�he lot •Existing and proposed utililies <br /> `Centerline of street 'Indteate North 5how any proposed grading changes •Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � 'i <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O ; <br /> 2.All woric shall be pertomied in accordance with this permit and curcent City of Everett Design and ! <br /> Construction Standards and Specifications. , <br /> 3. Call Locatfon Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1-800-4245555. � � <br /> �, I �� ,-}�I I ei�oS;a�� cos �frr I n 5 J �� �c-(cc� '� J., ',�, c �✓ork� �A ' <br /> � w s�LUlv✓_ �s�%ak1 � (os _ s', l� -�c�icc s • e-I c� O i <br /> 5 �v15✓')I�U�-{'t'� T� � � SI����S J �)O`�IC �C yYG�G� �� '`, �17c:� �CcJ�.n I�� I � I <br /> I / <br /> � -�Z) � V�l f,—Ct,4 , � . <br /> � (o . d>���� ��,i�rn I 9"✓r,�v� �IJ�IZ �,-� -�, ll �,: l 1 �c �I�cc� o.^ I <br /> I �N�Z� �.O.W. � ; <br /> ,.� , ;,�a�, 000ay�.,��1 <br /> � <br /> ; __ ._ <br /> � , i <br /> ;!`10097147 ' I <br /> ;-�:�:. „�3.,1Q � <br /> I �- �.��' � ...�.i� <br /> �a �Gr nI� kC �5 ��c�L; - ��l/,vtn �\� � <br /> I � � ACKNOWLEDGEMENTOFCONDITIONS � <br /> r� /_ The undersigned owner/applicant hereby agrees to hold and save harmless I, <br /> I �L(f'�-,`,-�1j��- --f 5/��!'/?� the Ciry of Evereri from any and all claims for damages,costs,ezpenses,or • <br /> � Approved for Construction Date causes of adion that may arise because of installation and maintenance of � <br /> I theimprovementorotherright-oFwayusaheretoappliedforandfurtheragrees I <br /> � to remove same upon notice irom the City and to replace public property i <br /> I damaged thereby. I <br /> i FINAL INSPECTION Date ! <br /> i Approved as Constructed /�; . , . . I <br /> ; � � - --�-� � -;;, ; -, � <br /> �, Signature of Applicant � Date I <br /> �� WORK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUEO TO I <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> � <br /> � I <br />