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Date_.2,l1,L.Ic 7, � <br />J - 35 =z9- �.. <br />Appllca�lonFor TO POST�NG .3 � 9 <br />PU LIC WORKS PERMIT <br />Print or Type Onl� `� 8 S`u� $ g g g g� <br />a ����� � ���� <br />J. W. Gaswin#, r� 720 Gran�Av� � � <br />Owner �eTett 98201 <br />owner <br />Describe Proposed Work <br />������������ <br />l 7 O'Z„ <br />Project qddress (if known) � <br />Zip <br />Attach four (4) copies of plans for proposed work - Draw fo scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ot ell existing and <br />proposed structures on the lot <br />• Existing and proposod utilities <br />Pu011c Wo�ks Parmll • �'�= <br />BIT,�. DeGI. � _� � �'��s �[ �i <br />PUGic Worka Fee <br />ToblFss i _ <br />Lvef Appl. Fee PeIG S <br />Bxleneo Due S �= <br />• Centedine of street <br />• Indicate North <br />• Show any proposed grading change� <br />• Show measurements <br />Phone <br />W <br />� <br />� <br />� <br />DO NOT WRITE BELOW THIS LINE m <br />PERMIT CONDITIONS O <br />I. All cel�s for tnspectlon shall be made 24 hrs. in advance • phone 259�$BjQ, <br />2• All work ehell be peAormed tn eccordance with this permit and cunent City of Eve�ett Design enC Constructlon <br />Standards and Speci(ications � <br />3. Call Location Underground Servfce 48 hrs. before you dig. TOLL FREE NUMBER 1•$()Q.4Qq.5555. <br />�� s� t�f �-I CCr1,�j' SbFhl� <br />s��D RN -*k 3p3 . <br />FI <br />�pproved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireat <br />Everett, WA 98201 <br />Phone: 259•8810 <br />�A� F� �St <br />Z-- Z= <br />Date <br />-�r <br />'� � O'F All._C—`( q� �� <br />ACKNOWLEDGEMENT OF CONDIiIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims lor damages, Cpsts, <br />expenses, or causes of acfion that may arise because of installahon <br />and maintenance of the improvement or other right•of•way use hereto <br />applied for and lurther agrees to remove same upon notice from the <br />City and to replace public proper,y damaged thereby. <br />S� na ure o Applicant ` Date <br />ORK AUTHORIZED BY iHIS PERMIT MUST BE STARTED WITHIN <br />780 DqYS OF DATE PERMIT !S ISSUED AND THEREAFTEq IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. ThIIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. . <br />