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� �PliwLon For <br /> PUB�UC WORKS PERMIT °a1e °��—�9� <br /> PUBLIC WORKS DEPARTMENT Public Works Perm�l N 3 <br /> 3200 Cedar Street — <br /> Evereri,WA 98201 259-8810 Building Permit R <br /> IYPE OR PRINT ONLY Public Works Fee$ e�0 �'� <br /> �a <br /> �o �QR �- FC�-,.,,e.- 2 �03 ME�oQa w,F�r 98 0� i -2a6 -2 �2-7980 <br /> Owner �Aatling Address City 2ip Phone <br /> Applicant IAailing Adtlress City Zip Phone <br /> Describe Proposed Work �r ¢ E " r�w 7 �L ��✓ w�c �f � <br /> �ll� S10LL V4�(G�N I-YONY �/MYK [ �r1 W A�� � <br /> / <br /> - <br /> � : b . :'•. N�� i,. . :i�,. , �"% <br /> PROJECT ADDRESS(if known) ��Q3- Me�ora.. �2 � <br /> Atlach four(4)copies ot olans for proposed work-Draw to scale and note the following if applicable: �C p,�15��� 3?�,O(} � <br /> �Property Lines �ONline and dinensions of all ezisting and proposed structures on the lot •Existing and pr0'�i�s6C utilitiesl�0�P.Q O <br /> 'Centedine of street �Indicate North 'Show any proposed greding changes •Show measurements � <br /> DO NOT WRITF_BELOW THIS LINE <br /> PER?,�IT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance -phone 259-8810. O <br /> 2.All work shall be pertortned 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-.i5S5. � <br /> � � ��'�1'lT ��CY-�-I�"� W F'a.t ���\Q.�'l,c?-�S Q� � <br /> ��''� �,���t� �-t."IR-'R_ �tzat'� 'L�,`�uc; �'` O <br /> -�C. �o `�M� `I��S . C�'C'� c^�F 0�-�T, � <br /> . �� �� � a <br /> . <br /> S` . <br /> -IrPpl..tc�o-�-� Tc,..�S� �. A-t��Act'ze o� `�-����u�+ <br /> �4�4ti-r� 'R�tcz�oc , �u_ �c_`t� �-v.� � <br /> �c . I�c�t� . ��--� �t,rt►Ac���J <br /> (o. �j� C3�/ Sfi�Gfs C��n dI` q�� fiir�?s <br /> ,�,� - 4(L c�irf fo 6� ,f'e�f or� si� - <br /> 'f <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> /- The undersigned owner/applicant hereby agrees to hold and save harmless <br /> (,� ZV ,(t � the City o}Everetl from any and all claims tor damapes,cosis,expenses,or <br /> C tor one ructi�� ate causes of action that may arise because of installation and maintenance of <br /> thc improvement or other right-of-way use hereto aFplied for and further agrees <br /> � / tu remove same upon notice from ihe CRy and to replace public propeAy <br /> ��/v(!"�G��i'�"- /- 2 2 -9'] damagedihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consimcted %� � � !I""d��b <br /> Signature of App�icant Date <br /> WORK AUTHOR2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PUFSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELIED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OYER 90 DAYS DURATION. <br />