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, <br /> � F� � ✓� �J� � �U f Wl e rt , �( C r e e k �a r���tl�/ <br /> i1ApplicationFor Date�.=l�J ��'/(� <br /> �iw�� PUBLIC WORKS PERMIT <br /> PUBLI ORKS DEPARTMENT Public Works Permit k ��� <br /> �0 Cedar Street <br /> �-vereri,�A 98201 259-8810 Building Permit# <br /> � O `S� <br /> TYPEORPRINTONLY � �� � ���N PublicWorksFee$ ��Z <br /> t��RIE�-1 Pfa.f��� N r-"r�o Set.�N'Ie�41A <br /> IN"�2Aca2'� 2505 2�� A�c'^ -� �1Q(Zf �oZS - `�ZZ�o <br /> Owner Mailing Add � .�o r� � City Zip Phone <br /> �u.�+�� W� t7uN tAP � � �z �� � �, <br /> Tivao c�,ssx ►t81�} U a�" �l�5 ��. ►4aK�,�1� WR 9803`� �z! - 8`�4�g - <br /> Applicant Mailing Ad ss City 2ip Phone <br /> Describe Proposed Work C�-EAfLt�1 G Ar�17 fLA t-� � I � 1 <br /> Y� <br /> � <br /> 7�' �LL�r// � � _ <br /> a �Ll.� � �� (/� <br /> PROJECT ADDRESS (if known) /y� <br /> Atlach lour(4)copies of plans for proposed work-Uraw to scale and note the following if applicable: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the I_t •Existing and proposed utilities <br /> °Centerline of street •Indicate NoAh •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shali be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be pertormed 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 /> �: �--�„r ap�'sy.l�/r'�� �a�� s=G �9 � (/� <br /> / O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> `r the City of Everett from any and all claims for damages,costs,ezpenses,or <br /> � ' �' causes of action that may arise because of installation and maintenance of <br /> A ed or ons ion i J� te theimpro��ementorotherright-of-wayuseheretoappliedlorandfurtheragrees <br /> � ///��� to remove same upon notica from the City and to replace public property <br /> �'. .��_i%G � 7�/ / damagedthereby. <br /> /f C � <br /> FINAL INSPECTION Date <br /> Approved as Constructed {J�G, �/J�/qb <br /> 7 <br /> Signature of Applicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED 8Y THE CIN UPON ANY STOPPAGE OF WOAK ON THIS PROJECT OVER 90 DAYS OURATION. <br />