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//C. :)___ e------ <br /> Date J 3‘) Public Works Permit# 7 T <br /> 4 ?w Application For qz Bldg.Dept.# <br /> K PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee <br /> Less Appl.Fee Paid <br /> Print or Type Only Balance Due $ 20 <br /> 002--322yr0//83/ <br /> c. 0 s_•—• bs..) /ireirt%.7 iit) -4-.---(_::.v•areztt y,_1,,(e.7'I— =-4"- ---4./ -1=4 <br /> Owner 3 Mailing Address City Zlp Phone <br /> 'J Ct_ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work I ( k t'-r,e iA-E 1 C t' gi%t-ram ' �I)1 - '- -�- ' , e L-is--/(___: A ,.'L <br /> / ifl i) �i� c-L ; t r t `}A.. ;-:.: • Pam..L,':mod-,.c+ c��`L-� �/ l,S-,% �c f„ 1.____. <br /> it <br /> /r` .7, Cr.,a ..elfd. — r 2o7�.- �L54�C//J' i41-aj)�A.eh t— A R c�. W <br /> � � 7 <br /> Project Address(if known) tE tik.,-X.12 i Q,ts CL- jFM. <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: Ii <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CCI <br /> DO NOT WRITE BELOW THIS LINE 0 <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction ....) <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 0 <br /> Ilmill <br /> CO <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 0 41/e,., s, The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> .)-? and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Ap ove for ons uc ' n Date City and to replace public property damaged thereby. <br /> , , Old 9 ---.. <br /> FINAL INSPECTION Date ...K �`.� / g . --j—� `� <br /> Approved as Constructed Signature of Applicant J Date <br /> 10 PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Cedar 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS •TO <br /> Everett,WA 9 Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> lifgiirCANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />