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� qpphtation For <br /> PUBUC WORKS PERMIT Date LO -z� -2� ' <br /> PUBLIC WORKS DEPARTMENT Public WorY.s Pertnit F� _ <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 Building Permit#_ � �2� <br /> IYPEORPRI^1TONLY �UG�Cb +'�s PublicWorksFee$�/ p0 BP <br /> �cj�c.� 335-7(37 <br /> A�r►�� �i�l7�- wr��J <br /> ��v� �-�ren_='n1������� �R� ►� 3S5'1Z53 <br /> Owner Mailing Addresa Ciry Zip Phone <br /> ; �Rc.��iL ('c�i I�c�nJ �'c�` 9 9�5 za 'l.�< .Sk�cin, ,�U,)�_ 54�258 33�f -�?�s <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �l2CK-111�b ���0 �b27 l'L{��_� � <br /> ��D� <br /> 2�P C��. 1'�-�b7�n� '�CU -{�}o'va' ��� '�CO Sa l� � <br /> b2 �SF 0 � �G�-�} �i1v�� O� d�� Mf ♦/� <br /> �i <br /> PROJECT ADDRESS(if known) �b2—] 1�17��� F PZ Y��r���a�� �p <br /> Attach four(4)copies of plans for proposed work-Oraw to scale and note the f�llowing if applicable: O <br /> •Property Lines •Outline and dimensions of all ezisting and proposed stmrWres ou Ihe lot •Existing and proposed utilities <br /> •Centedine ol street •Indicate North •Show any pmposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. All work shall be performed in accordance with this permit and current City oi Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> 9 keep c�fy ,s{�r�e�Fs e(rz4� Q� aLl -f�mes O <br /> J�, �rovr'dt Qnj/ P.+-r�srol-> Con�'�roL QS c�ir�c�eC( � <br /> by -{(�c p�6G� [.Jo��Ef TnsPec�or, �So.�e iti pLa�e ho�� <br /> �',.� <br /> __ ,;_; <br /> Cov�v-� B�S�PA �cr po✓Q Le�- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> — The undersigned owner/applicant he�eby agrees to hold and save harmless <br /> �� Z 4(� the City ot Everofl Irom any and all claims for damages,costs,ezpenses,or <br /> proved ty Co� i . Date causes of action Ihat may arise because ol installation and maintenance ol <br /> the impmvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the Ci1y and to replace public property <br /> /i��e �� ;,��' .S'� damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed � /1 <br /> � % <br /> Signature of Applicant ate <br /> WORK AUiHORIZED BY THIS PERMIT MUST BE STARTED WIT}iIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfEP IS TO BE DILIGEN7LY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIlY UFON Ai�Y STOPPAGE OF WORK ON 7NIS PRQIECT OVER 90 DAYS DUFWTION. <br />