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' Appliw�ion For / <br /> �� PUBLIC WORKS PERMI'T Date�/8/9� <br /> . <br /> PUBLIC WORKS DEPARTMENT Public Works Permit!I __ _ <br /> 3200 Cedar Street <br /> Everett,WA g8201 259-8810 Builtling Permit N _ <br /> IYPE OR PHINT ONCv Public Works Fee S � <br /> �.,a,.-..t.. 7- �,c�-v. �' /..c, —..v:.r_�G�1 C. � ,35.3 O <br /> Owner Mailing Address City Zip Phone <br /> f�0. /�1.�_ �8 9� ��-s_tf Lc�w %�.,2�� <br /> Applicant Mailin9 Address Ciry Zip Phone <br /> Describe Proposed Work ��+ c7� C �� ��%�� a � <br /> C' R. ' f-oF wa � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) O/S— � � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines `Outline antl dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br /> 'CenteAine ot street •Indicate North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <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 Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �{ h?or/C' �K.s'{i�f fe�,c� 4S S'�oc✓s, Oh o�roGii� v/ <br /> d4�E� ¢.�-9� O <br /> a <br /> /J ACKNOWLEDGEMENT OF CONDITIONS �� <br /> �i���!/lf� �OC��-� 7��/9/ The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> the City of Everett from any and all claims for Aamages,costs,expenses,or <br /> Approved r Construction Dat causes of action that may arise because of installation and maintenance of <br /> the Improvement or other n9ht-of-way use hereto applied tor and turther agrees <br /> �� c /�� ` �/����� to remove same upon notice fmm the City and to replace public property <br /> ��/`L_ _` damagedihereby. <br /> FINAL INSPECTION Date � <br /> Approved as Constructed 1 <br /> � %M^w✓ ✓�� �.µ.echl� <br /> Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTIY PURSUED TO <br /> COMPLEf1C��.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THiS PROJECT OVER 90 DAYS DURATION. <br /> � <br />