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f�f <br /> 4 <br /> Application For ci d��J-^^ <br /> PUBLIC WORKS PERMIT Date.77 <br /> PUBLIC WORKS DEPARTMEI -7 _04 (;) <br /> Public Works Permit# /8/960 <br /> Cedar Street ° FvV ��Og4, <br /> Everett,,WA WA 98201 259 88s Bye ni#4l" I <br /> 0 0 <br /> TYPE OR PRINT ONLY Public Works Fee$ ZO <br /> �.?-h•� Vl # i C' l — "d" (:I''1�I � "^� EL ?iTh: QK2° <br /> 4. _i C <br /> Owner Mailing Address City Zip Phone <br /> t� i I , <br /> Ja,0 i ..„ 1 tc Vim.. ! �-- f c j � i, tie c ur r t—A„. � <br /> Applicant Mailing Address ,), i City Zip Phone <br /> ip <br /> Describe Proposed Work a. ( i , f �✓ , t. - " , _t+ U <br /> 6 - * ( 1 �. <br /> ��J — <br /> aw• <br /> \ . <br /> PROJECT ADDRESS(if known) ..) �. c_U I \. � �.-.�% �' i-\ .... <br /> Ca <br /> Attach four(4)copies of plans for proposed work--Draw to scale and note the following if applicable: <br /> 'Property Lines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities 0 <br /> 'Centerline of street 'Indicate North 'Show any proposed grading changes 'Show measurements <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <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. iiii <br /> 4r c t'-t S+ c L.c?cc IF'1 t: 4 1 Y I e.5' <br /> 5 Ai <br /> O �1, c l c, 1 be cJo C 1 r- 1tOU 4cjt i T✓O hat'pi�l^r�.1 <br /> O. <br /> 6 , Ar,y #C Z-cteNc/o 01alek-te �s slict L . ®� 01,sposed <br /> a- ' Pr^operc.y <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> 4 7 9 g the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approv4"/ <br /> „L./CZ <br /> onstruction D e causes of action that may arise.because of installation and_Maintenance of <br /> • the improvement or other right-offway use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> damage thereby. f43, <br /> 1FINAL INSPECTION Date <br /> Approved as Constructed ( ! <br /> igdature of Applicant 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 />