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� <br /> � �PI¢ation For — <br /> PUBLIC WORKS PERMIT Date_ 7' ��� 97 <br /> PUBLIC WORKS DEpqRTMENT Public Works Pennit M 97 ZQ � <br /> 3200 Gedar Street — <br /> Everett,WA 98201 259-8810 <br /> Builtling Permit M <br /> IYPE OR PRINT ONLY Public Wcrks Fee$ <br /> 2c� po <br /> BK <br /> mARG%e ,v/cHo/sol✓ /A�S Rk�keie EW��tf 9pzoi zsz- �o q <br /> Owner Mailing Address City Zip Phone <br /> (��sT c-o.✓y�cN.c„a✓ 35ZS' i32 ~sfs✓ `t��a-ooJ y8os� �Y3-i6i.5_' <br /> Applicant Mailing Fdtlress City Zip Phone <br /> Describe Proposed Work ����«+ �u'ti� J/�*-FS yo ?he �re�.� <br /> i_ �hKo�� �.,e � <br /> � <br /> PROJECT ADDRESS(if known) �5 iQ�Ck e.0 ��e E w � <br /> Aqach four(4)copies of�lans for pioposed work-Draw to scale and note the}ollowing if applicable: � <br /> •Pioperty lJnes 'Outline and dimensions of all existing and proposod structues on the lot •Existing and proposed utilities O <br /> 'Centerline of st�eet hndicate North •Show any proposed grading changes •Show measuremenis � <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. O <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> 9, Z//SfaCL Dsai�� PL� �'i-{� S�¢i��i.c+� �.3/`J v♦ <br /> O <br /> a <br /> o7-io-97 z:27PM <br /> k 97c^01 <br /> OTNF7t 20.00 <br /> TOTAL 20.00 <br /> CHEFC 20.00 <br /> A OR BBO <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersignr]owner/applicant hereby agrees to holtl and save hartnless <br /> �- 7 �� _9 7 the City ol Everett from any antl all claims for damages,costs,expenses,or <br /> Approved onstruction Date �auses ot action that may arise because of installation and maintenance ot <br /> � -, � iheimprovemenlorotherright-of-wayusaheretoappliedforandfurtheragmes <br /> / / 7 to remove same upon notice from the City and to replace public property <br /> /� �lrl�. � �-��.`. 7/r �/y� damaged thereby. <br /> FINAL INSPECTION Data <br /> /lpproved as Constructed <br /> � �/o-97 <br /> naWre of Applicant �a� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITH!N 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 />