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� `'i <br /> � �plication For <br /> PUBLIC WORKS PERMIT oete�6/97 <br /> PUBLIC WORKS DEPARTMEN7 Public�lorks Permit k —� 1 <br /> 3200 Cedar Street <br /> Eve��t'.W/f9�20�259-8810 Bulldin�Permtt N�jy525 <br /> Tn POSTING'-- �� <br /> IYPE OR PRINT ONLY Publle Works Fee S�` <br /> ]rL7 J V OOO �Y O •-IO �70 47 <br /> 2 r V U U O �) O 1 A O O O O h 7 O� <br /> p�J . . ��7 . fl • U <br /> .n l L'I O d O �-1 �? �-1 N <br /> HOl1N5HF.L1. Mjj(r 21020 67TH 7� •W(N1D •9�9(lmi(y� ro7�tlaj�� - <br /> Owner Mailing Atldress ..�, CiTy � �ipi ¢ Phone <br /> CONTACT: ROR PF.�� � c o� c� w cc :t �-�. � <br /> Applicant Mailing Address �' ,., � ;� ' i , �- 3 � Phone <br /> .~-Ia w � Zc�noa3avWi � f" <br /> Describe Proposed Work NEW WAREHOUSE/OFFICE � <br /> � <br /> �/ <br /> PROJECT ADDRESS(if known) 2q15 � <br /> Attach four(4)copies ot plans for proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Ezisting and proposed utilities <br /> 'Centerline of street •Indicate Norlh �Show any proposed grading changes •Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shall be rnade 24 hr.•��in advance- phone 259-8810. O <br /> 2. All work shall be performed in accordancc�with this permit and current City of Everett Gesign and <br /> Construction Standards and Specification�. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �'. R2w�D�G rr� vt��l�cc ex,sti�y dr�vcu.���-Zo ���� s�� � <br /> W;'�n Fi/t 1 h Bi�v��' Gu r�o tJ-tlt�l' � S� �...2�,1 K- �•Ma�G O <br /> �'wicro�% -Fst�w� Pz rkws..,, s�h-�p f rcP��Hf w��c ��s�, a <br /> � �7icic Se.��- ��W s'fd fJIT,� �-`6O/ - G�drr,u�� �n�fr <br /> -� s,-dc se�.-r-,�= � <br /> ; <br /> l�� ACKNOWLEDGEMENT OF CONDITIONS <br /> �i�� � �p/��� The undersigned owner/applicant hereby agrees to hold and save harmless <br /> �� A `� the City ot Everett from any and all claims for damages,costs,expenses,or <br /> Appr ed or nstr� Date causes of action ihat may arise because of installation and maintenance ot <br /> � theimprovementorotherrigh4of-wayuseheretoappliedtorand}urtlreragrees � <br /> to removo same upon notice from the City and to replaca public property <br /> � ����/ ���� damaged thereby. <br /> FI AL NSPEC•i� Date / <br /> Approved as Constructed ` , / / ! / `p� <br /> � 4/ /� / <br /> a ure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF D PERMIT IS ISSUED THEREAFTER IS TO BE DILIGEN7LY PURSUED TO <br /> COMPLETION.7HI5 PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOP AGE OF WORK ON THI Pf 0.1ECT OVER 90 DAYS DURATION. <br />