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� APPl�cation Por Date � � �� — —/� _ . <br /> PUBLIC WORKS PERMIT �,! <br /> PUBLIC WORKS OEFARTMENT publir.Works Permit N / � �7✓ <br /> 3200 Cedar Street <br /> Everett.WA 98201 259-8810 Building Permit q <br /> TYPE OR PRINT ONLY Public Works Fee$ ���n <br /> �4-�U�i. � Po�l �..`0.f��JI�. $06, 6. �l ;a...� 2;d�aflf. �t�e'ff' 9$7.03 3a?�8081 <br /> Owner Mailing Address City Zip Phone <br /> So�.,ti.� o�s cxbo�.a- <br /> Applicant Mailing AdJress City Zip Phone <br /> DescribeProposedWork R¢+w�� ^l'°� 2� J''�'s •f ���"`�`�l� `�`'`'"''p.d ,.,�.)�er1.� W <br /> ^ 0.�ia. b C <br /> �..r+� das�.J b':w.1.+3 � G4n`s1�ai+ 'Rc�-S Y:...w.�� we"t.o.�-e'� {� �l �1!`"r, ���� 7jOrC•`� � <br /> ! <br /> �� 0.T �o�.•l-� .T Y���a. b�.a«."�` G�� �Q� N.wt. �atC.r W nrlu� W/.7i� ��w <br /> �{p.r�'LCw � �Q�M 1�LG.l eY.-ih�s S/[ 0. _/ I <br /> PROJECT ADDRESS(if known) _ .�'s'O li r• U'�...a R:dt3,.. �Dr. —���� e.��R of f�+•-� P��+-"- <br /> Atlach tour(4)copies of plans for proposed work-Draw to scale and note the following if appl�cable: � <br /> •Property Lines 'Outline and dimensions o1 all exisling and proposed strudures on the lot •Existing and proposed ulilities O <br /> •Centedine of street •Indicate NoAh •Show any pmposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS: 04/25/96 2:�IPM OOORH551 �kc <br /> 1.AII calls for inspection shall be made 24 hours in advance - phone 259-8810. O <br /> 2.All work shall be pertormed in accordance with this permit and current City of F���sign and <br /> Construction Standards a�d Specifications. „ <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM�-800-�-:.��55. ` <br /> r <br /> `� /�c�P c%fy �'f�E�fs cL��� af QCC f„�es � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hemby a9rees to hold and save harmless <br /> ���y !� � ��' the City of Everetl from any and all claims for damages,costs,expense<_,or <br /> causes ol action ihat may arise because ol installation and maintenance of <br /> Approvedfo onstruction D te theimprovementorotherright-ol-wayuseheretoappliedforandlutlheragmes � <br /> �J��� ,/ /� /y� to remove same upon notice from the City and to replace public property <br /> �� � � damaged thereby. <br /> FINALINSPECTION Date �� �� /,�� <br /> Approved as Constmcied � �� <br /> Signaturz of Applicant r� ,� Date <br /> WORK AUTNOPIZED BY THIS PERMIT MUST BE STARTED WII�HIN 1�0 DAVS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO BE DILIGENTLY PURSUr'J TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BV THE CIN UPON ANY STOPPAGE OP WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />