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��� APPlication For — <br /> PUBLIC WORKS PERMIT Date�.�(1�28' <br /> B 9 �,��— <br /> PUBLIC WORY:S DEPARTMENT Public Works Pertnit M <br /> 3200 Cedar Streel <br /> Everett,WA 98201 259-8810 Building Permk N <br /> O� <br /> T.'PE UR PRINT ONLY Public Nbrks Fee E �S S <br /> y��8' <br /> IYLtGNwhfi W✓AJr:�.l �o�n �.� � JSO1C �J� U2��Q ✓I.�L WU.!'�.. �aa9 64�� 5'�+fnJa. <br /> O�wner Mailing Address Ciry Zip Phone <br /> .S0.�-n �L <br /> Applicant Mai�ing Address Ciry Zip Phone <br /> Describe Proposed Work 6 � � �.o S 3 i=�e� � . .f � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) Lo t Sl3 S:.ue.r, CE+,'h�r '-11-98 1: 8!' 1 � <br /> � ' „ Yt�_��.. � <br /> Attach tour(4)copies of plans lor proposed work-Drew to scale and note the following if applicable: ��;;i_.,� 1��; �,,, O <br /> •Property Lines 'ONline and dimensions of all ezisting and proposed strucWres on the lot •Existing ih�1 pibposed ul@t{Bs.�i <br /> •Centedine oi street •Indicate North •Show any proposed grading changes 5how measurertfi7i8_;, �'r i,v';i � <br /> „ <br /> DO NOT WRITE BELOW THIS LINE ~ r, ;J y„�S:` ���, <br /> PERMITCONDITIONS: � ;,�g.o� <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 City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Servico 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � f'.�,, �'�►,�,�• ��/� ����� 9 -// - 98 � <br /> :� _ , � a <br /> . �-5� __ <br /> � s�_,_;: <br /> c� �,::.4 v <br /> L.t"i:=�. _�5. .� <br /> 1 `(_, <br /> ACKNOWLEDGEMENT OF CONDITIONS , <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � / e City of Everett hom any and all claims lor damages,costs,expenses,a <br /> Ap v� or Con tr i n � D causes ot adion that may arise because of Installation and maintenanca oi <br /> / the improvement a other rightrot•way use hereto applied for and further ngrees <br /> � .� to remove same upon nottce tmm the City and to replace public pioperty <br /> ���,��� 3—/��,` _ f' dama.�edthe�eby. <br /> FINAL'INSPECTION Date • <br /> Approved as Constnicted e� �7 �� �i/��J <br /> � <br /> Sign ture of/lpplic Date <br /> RK AUTHORIZED BY iH15 PERMIT MUST BE STP97ED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFTER IS TO BE DILIGEMLY PURSUED TO <br /> PLEf1QN.THIS PERMIT MAY BE CANCELLED BY THF.CITY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 90 DAYS WRATION. <br />