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•1 � <br /> �,, PUBLIC IMPOaRKS PERM[T Date� z _ z�- <br /> PUBUC WORKS DEPqRTMENT Q�� <br /> 32�0 Cedar Street Public Works Pertnit p <br /> Everett,WA 98207 259•8810 <br /> IYPE OR PRINT ONLY Building permit p <br /> � Public Works Fee$ <br /> ow�er Q h �^ /ilCl pi � V��^� /�/� q��� � <br /> Mailing q dress Q !_ <br /> City P � <br /> Z� Phone � <br /> Applicant Mailing qddress <br /> City Zip <br /> Describe Proposed Work anone <br /> r' � r l.� <br /> W <br /> N <br /> PROJECTADDRESS(if known) 2/ _ � <br /> Attach four(q)�opies of plans for ro os Q ^ � <br /> P P ed work-Draw to scale and note the following if applicable: M <br /> �ProPerty Lines butline and dimensions of all existin and ro <br /> 'Centerline ol s� . 9 P posed structures on the bt •Exfstin and W <br /> ^�1 Indicate North •Show any proposed gradin chan es • 9 PfOP°sed utilitles O <br /> �'' 11`�� 9 9 Show measurements <br /> E�� PERMIT CONDITIONS: �O NOT WRITE BELOW THIS LINE ' <br /> ';;�.:,;, , <br /> �,: '; 1.All calls for inspection shall be made 24 hours in advance- <br />' 2• All work shall be performed in accordance with this pertnit and current City of Everett Design and � <br /> phone 259-gg�p, <br /> 3. Call L cation Underground Servicef48thrssbefore ou di . TOLL FREE NUMBER 1- <br /> 1 y g O <br /> 800-424-�5. � <br />, �,��'�` ��� � � <br /> �� ��,� �,,�,G�, ��, /O� <br />� C ���-�' �'to.T/` Oe�Q�C�I'7 ����'C�� /�r/(. OSO F `i <br /> �" o{' �I�eYJ Co�- �,�ed <br /> C��- Cov,�L �f2�/' 9;,�,��` vr��-io.�ce <br /> �3 /�. /io Pp.� <br /> s��t,o� - ��o,�y a,ya��o,� <br /> � ..f� 3 /� <br /> � <br />�� ACKNOWLEDGEMENT OF CONDITIONS <br /> I The undersigned owner/applicant hereby agrees to hold and save harmless <br /> APP��etl for Construction �he City of Everett from any and all claims for damages,costs,ex <br /> i'� Date causes of action that may adse because of installation and maintenance of <br />� the improvement or other right-ot•way use hereto applied for and fueher agrees <br /> i to remove same upon notice from the City and to replace public p�pem, <br /> FINAL INSPECiION tlamaged thereby. <br /> APProvM a=ConslructeC Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN 180 DAYS OF DATE PERMIT S ISSUEID AND hIEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY AE CANCELLED BY THE CITY UPON qNY STOPPqGE OF WORK ON THIS PROJECT OVER g0 DAYS DURAiION. Date <br /> I1 <br /> I <br />