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Application For <br /> OP#4s,-- --A PUBLIC WORKS•PERMIT Date '/t 1192' <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# 9 6 60 <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 <br /> Building Permit# <br /> TYPE OR PRINT ONLY Public Works Fee$ S54 <br /> (��� pp , q yas-4Y6-a'31k <br /> 1,tencvrrwt CO arc4101,, p, . fi 130 13c. IIe v e... ija ri , ,o9' G col a ,Skeruut, <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work, G1^4 411 40 f-' .a t3 `v.ei-c-#.f'. . 4),/. .f"t�cza, L. Co, <br /> C S 6' `l,F-1G> ) i <br /> 09-11-98 1:48PM <br /> PROJECT ADDRESS(if known) L6 fi .3;. . t" a e � ` ' <br /> Attach four(4)copies of plans for proposed work Draw to scale and note the following if applicable: OTHER 175.00 <br /> 'Property Lines ''Outline and dimensions of all existing and proposed structures on the lot 'Existing Drfnnaposed, utvipotj 0 <br /> 'Centerline of street 'Indicate North 'Show any proposed grading changes 'Show measurerOMER 279.00 <br /> TOTAL 55' ..J0 <br /> DO NOT WRITE BELOW THIS LINE , Ty, <br /> PERMIT CONDITIONS: A 0M8166 <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and 0 <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> , / e 1 ,Z.1/ ? -iif— 9 8 4 <br /> tze/Pelf 7/2/-A.— ,/,. 60-- e-e <br /> CO <br /> 0?..:".1-9 1:47PM <br /> fl 98280 <br /> OTHER 554.00 <br /> TOTAL 554 00 <br /> C.HMI< 5'54e 00 <br /> ,P! '.081.:=_. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ---"""`— The undersigned owner/applicant hereby agrees to hold and save harmless <br /> „/ `the City of Everett from any and all claims for damages,costs,expenses,or <br /> causes of action that may arise because of installation and maintenance of <br /> A., for Constr: ion �i = e the improvement or other right-of-way use hereto applied for r and further agrees <br /> to remove same upon notice from the.City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date bc, <br /> Approved as Constructed i J .7 <br /> , ,,,,,,t„,,,__ie <br /> -il-y," <br /> , • <br /> Signature of Applicr t Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE-DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90'DAYS DURATION. <br />