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Application For �, A��j^ <br /> 10477 PUBLIC WORKS PERMIT Date �/r <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# lC7! ZZZ <br /> 3200 Cedar Street Everett,WA 98201 259-8810 <br /> B��' Pill f 40 3..DC�� <br /> trig Permit# <br /> TYPE OR PRINT ONLY Public Works Fee$ <br /> O$EPA-- M, -,i -ENL- 2 2 u., IA-Klefti, V i EN A , q i .-2 -'-al1 <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone ........ <br /> t <br /> Describe Proposed Work e , 0-14 L--0 o 1 .1 t!. <br /> KJ° A 9 > ./ �a T W <br /> I— <br /> PROJECT ADDRESS(if known) Wm <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 y gq ed tilitiTr N? <br /> b ii. On <br /> 'Centerline of street ■Indicate.North "Show any proposed grading changes •Show measurements i <br /> �_� 3 L3. 2 inl <br /> DO NOT WRITE BELOW THIS LINE � �><s <br /> ° PERMIT CONDITIONS: Z <br /> C"`'�^ "0' `�"00 <br /> - s-, 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. iiELf` "'- <br /> . 2. All work shall be performed in accordance with this permit and current City of Everett Design and O <br /> 3 c Construction Standards and Specifications. <br /> 1- NI 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> 0 <br /> — -,--- 4 . i!vi t�A411 e �`o t o r i co►�1 r I , c�i r'cc-t ,1� Q� I \\fort s co <br /> t tis 7ec-t-i>� O <br /> 0 1 <br /> J, )( , +.►) 2 ‘i »t- l wick,' I2CX -#` t � 1.1 , lip � deg tv i 9cd 1,-Ai <br /> �. <br /> v cs COl fa'�"1��tactfo► Viet 11 126 C i(tsd 0Y (6p 1 C&I A 'I4Ve 193e( <br /> L <br /> < 41 \ GW1 CE to b C�Vt 4' t (— ,cfie\\/Gt(„ <br /> 4- O :"1 4-k; .5 r- iCG �041iel9e, :: Ilet 1 cy ( C) k• t\C*Peiir- � ' l`G' rt CC�� <br /> ) -D eta 1)6 J; re,c -�1or� 0-C -he, e J1�C \va' c i �suet--for; <br /> = <br /> J IA', <. /�i �`io\ied -(1, <br /> 0 �z. �\'l� �f; >7Cn'1•i G✓1 �a � 1 _.,,;��� ��'�' G'!t l I Y11 '�C'r^ k cr <br /> 4-k', s '1+c sha 1111ekve, VA rid pccril i i -4 r r'G Ge;,1 t,1 -*ke iecfe r:et 1. <br /> c)C r' AA rill ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> 7) !//C, s✓//4"14/676 the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for Construction Date causes of action that may arise because of installation and maintenance of <br /> the improvement or other ri t- f-way use hereto applied for and further agrees <br /> to remove same upon n tice from the City and to replace public property <br /> ctamatged thereb,.. <br /> fl , ,i r <br /> FINAL INSPECTION Date ' <br /> Approved as Constructed f ! / /4 �)/ <br /> St4nature 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 />