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6 <br /> Application For <br /> 4.77. <br /> PUBLIC WORKS PERMIT Date <br /> PUBLIC WORKS DEPARTME Public Works Permit# gs/Z627 <br /> 3200 Cedar Street > d <br /> Everett,WA 98201 259-8:.• <br /> ,, Building Permit# <br /> TYPE OR PRINT ONLY Public Works Fee$ 20 <br /> e ve Noel 1532. tic Ket' tier . rent tk 98201 339.e50.3 <br /> Owner Mailing Address , City Zip Phone <br /> SJ Ell <br /> Applicant Mailing Address City - Zip Phone <br /> Describe Proposed Work cdt^ veA y ' Itotii 6tAreet, -ko acie- p2i-ki v►c la <br /> pA3 --L.,0 be, ai i trocte ovi 1 <br /> (I) <br /> PROJECT ADDRESS(if known) 1532- ' f OC ke•cc&( Ave., <br /> Attach four(4)copies of plans for proposed work Draw to scale and note the following if applicable: 1111 <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot Existing and proposed utilities <br /> ''Centerline of street 'Indicate North "Show any proposed grading changes 'Show measurements <br /> DO NOT WRITE BELOW THIS LINE <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: OZ <br /> 3:Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-800-424-5555. F <br /> 4. Ai, pe( Arroved r(Avi dAied cf-4-613 <br /> . ,,t7,,-i, ► ,fe rk, ; t_, 9 .t e, ,re, m( -fir 0 <br /> ;►i l,A9 o I"e r A.'s oil 0-' -01-e.. '6'6(CGt-L-re.6 ,014 t(0 S ieto _ a <br /> :,. c, tt t 1 geo IA ;5 6A.61e 0-1,1 ., 33q - -03 -f p r prer606fru61~i011 <br /> coo-F 'eti7Ge pr•:car- - :n i ear 5tecic-t1 ova 4v d i5Cv.'s <br /> 4v t-,teAt- o-f - k. v- t� . 3(.7 c. <br /> less <br /> f fACKNOWLEDGEMENT OF CONDITIONS <br /> ( f ✓v The City of Everett <br /> owner/applicant y for es to hold an x enshares,or <br /> CLGCQ, the of fverettYrom any and all claims for damages,costs,expenses,or <br /> causes of action that may arise because of installation and maintenance of <br /> Approved for Construction Date <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date I n <br /> ,+Approved as Constructed i ,7L /,i c� <br /> signature of Applicant ! .4- <br /> f <br /> 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 />