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FI nti Rf �3 c � - �a��.� sk <br /> .� tiPPhcatwnFor �....�.-•.r ^`'P ZB � 1�_-- ___ <br /> PUBLIC WORKS PERMIT °a'e = <br /> PUBLIC WORKS DEPAHTMENT Public Works Pertnil k � �7� <br /> 32D0 Cedar Sireet <br /> Everett.WA 98201 259-8810 Building Pertnit k. _ <br /> TYPE OR PRINT ONLY Public Warks Feo 5 •3's�� <br /> BK <br /> 7,-�� ) (�. „ _ ii�l� P . :.'�., , . .: T.��L. '... 3�. — nn�r <br /> ',IL...� l.. I' ;T';i:� 1 _0:; _:1•. � S1;iC' t . ' > 'n - ,� n n�•, _�;�nq 2 2-.. � <br /> Owner Mailing Address City Zip Phone <br /> _ _,;; ?;. ro�^LT'?', 13oa-•�•'-t1, �TP,LrT #n, �t1�RF,TT, lva �5203-2227, 252-92�`� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 1"31:+�LL G,91tDPN SFAC;. A7,�?;G 3^rd ST_nrrT t�t.;n PAI'P? STItEI;T :` � <br /> _:iG::? , ��;:;." ';'?"iI: CITT OP �V�ItC'PT PLANNING D�PART1,'�i1'P. ` <br /> r <br /> � <br /> PROJECTADDRESS(ifknown) V:�CANT LOT AT �3rcj �>treet r.nd Paine Street — <br /> � <br /> Attach bur(4)copies of plans for proposed work-D�aw to scale and note ihe lollowing if applica6!e: � <br /> •PmpeAy Lines •OuUine and dimensions of all exisling and proposed structums on the lot •Exisling and proposed utilities O <br /> •Centedine ol street •Indicate North •Show any proposed grading chznges •Show measumments � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. 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 Cily 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 /> 1— <br /> '%r� ✓, �/ .7 �f 'J� �-=.:��.'i;,�..1� G9��Ut>���,,,-,. , �'..; . �,v' � <br /> , J . <br /> ;�!4�er/ Di1 Crf� r!9/rf-of- G�a�, ��er� I>lon��:.,. � <br /> !�vie.� jJr�ccss 1 "�3-9�� <br /> . <br /> . :;��, ��, �< < ,l� --< .-, ,� .,';,,: . <br /> ,oca6::e <br /> ,;,� s35. . <br /> ACKNOWLEDGEMENT OF CONDITIOIJS <br /> 1� j ;� � The untlersigned owner/applicant hereby agrees to hold and save harmless <br /> � F �� Jy�,, .f� �,�/c�� 'y� the City o(Everett from any and all claims for damages,costs,e.penses.w <br /> '�� '� �' �'�'`� � �'�' �" causes of action that may arise becauso of installation and mainlenarce o( <br /> Approved j r Construclion Dat the improvement or other right-of-way use hereto applied fo�and furiher agrees <br /> to remove same up�n nofice from the City and to replAce public property <br /> damaged ihere6y. � <br /> FINAL INSPECTION Date � <br /> i <br /> Approved as Construcled �� {� �} �'��C�,_ '�_ i(� <br /> i <br /> Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST OE STAR7ED V.'ITHIN iB0 DAYS OP DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTIY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY�E CANCELLED BY THE CIIY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />