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TYPE OR PRINT ONLY <br />� -�=f- �-1-� <br />Application For /// <br />PUBLIC WORKS PERMIT Date_(p/ 2� 96 <br />/ <br />PUBLIC WORKS DEPART "VT <br />3200 Cedar Stree� <br />Everen, WA 98201 25s . 0 <br />Public Works Partnit N <br />Building Permit # _ <br />Public Works Fea $ _ <br />�ZS/ <br />������ <br />�35po <br />�3P <br />CLA�. �ISiR,l6uClt�i � Z.2o2 '3(oT�ST �fl��t-WA. �I�ZO� '1�fo'252— (o1Db <br />Owner Malling Address City Zip Phone <br />W <br />ApPlicant <br />Describe Proposed Work <br />Address <br />PROJECTADDRESS (if known) 3�TM ¢ <br />Zip <br />Attach tour (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 <br />'Centerline of slreel •Indicate Nohh 5how any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <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 <br />Construction Standards and Specifications. <br />3. Call Locaticn Underground Service 48 hrs, before you dig. TOLL FREE NUN�F��,9-�00q ��4�-�5 <br />��j .,e q00096251 <br />�7c.'�P C�� ��� C�¢4h R7'� Ql� [!/�?e.�' gPqDNG 5135.D0 <br />S :�/!3 � t / / CtiiCl: f135.00 <br />/� fD !/C �0/7� fit2i" �p�pnS t��P�'o✓e d <br />� 7-9-96 . �Co�'/ Q�a�%ied� <br />� ����,�8 ��y Q���o�2� �-,�s;�.h ��,�.-�� <br />2s o;.,�cf��! �jy ���c f�fiL,� l�.o�.,F.c 1;,s�ccfo,�. <br />APPiov____� n � ey <br />/ , <br />FINAL SP ON Date <br />Approved as Constructed <br />W <br />H <br />��/� <br />V♦ <br />�'k <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONOITIONS <br />The undersigned owner/applicant hereby agrees fo hold and save harmless <br />the City of Everetl from any and all claims for damages, costs, ezpenses, or <br />causes of action ihat may arise installation end maintanance of <br />ihelmprovementorotherrigM- -way eratoappliedforandfurtheragrees <br />to remove same upon n e i Ity end to replace oublic pmperty <br />damaged the� � <br />WURK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLE710N. THIS PERMIT MAY BE CANCELLED BY THE CIlY UPON ANY STOP°AGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />