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\ <br /> � _. APPhCalionFOr <br /> PUBLIC WOR�CS PERMIT --��, .� t �S � <br /> i � �' `` <br /> Date <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit k _�S S72 <br /> � 3200 Cedar�2et <br /> Everett,WA98201 0 259-8870 <br /> � duilding Permit N <br /> TYPE OR PRINT ONLY == �; ��� <br /> �� v? va Public Works Fee 5�✓`O�' <br /> �:� �; ... <br /> •r :a <br /> � �� ' 1��i�c�/T�' ;1.3/JPc�'� ' �✓ � J- <br /> ic. c / `-?/ � CYi' S /o/ <br /> Owner Mading qdtlress o;� a �. " City ZiP Phone I' <br /> � C O LLI C� �(�l�C �l ./%/L� <br /> G S W <br /> - PP � � .�. a � [� CC t C ��GJOr�CS <br /> A licant M ng Atldress � Cit Y <br /> Y Z�P Phone <br /> Describe Proposed Work_ G� t�' ,� �µ � w�S r. <br /> / u,J ,P E 5 W <br /> � <br /> � <br /> PROJECTADDRESS(if known) .;2 a.C/!tn �i� ��n�� `�� �, � �/ <br /> Attach fou�(4)copies of plans for proposed work-Draw to scale antl note the following If applicable: m <br /> �Property Lines 'Outline and dimensions of all existing and pioposed structures on the lot •Existing and proposed utilities O <br /> •Centedine ot sireet •Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calis for inspection shall be made 24 hours in advance- phone 259-8810. � <br /> 2.All w�rk shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Sen�ico 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424-5555, <br /> • '! �pO�.E �o � �nG��:r .0�4.� de'S.p�,� 6y � <br /> �7 v,v ler.GT �R��.� �.E, S�'r fC' `� � <br /> � /2 Z�-YS O <br /> � IJ�`°'�' C fj� Sf vt�'f3' � /�CC�� C�c4.� c..7� 4�C f mE'.1' <br /> �� L��7>ir/EC/^ n'1US/ h'!a�'�' Q (/iSC�r. 0 ` � <br /> ro�,�,:� dur i3, 755c r ,F �nsPct f.e�, o F f�,.� <br /> oc c�y co.,sf.�,�_t.nr� . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ��� �` �, / The undersigned ownedapplicaN hereby agrees to hold and save harmless <br /> � �..4/�- 9/s. the City o1 Everett from any and all claims for damages,costs,expenses,or <br /> Approyyo ror t,o ru Iion /Date causes of action that may anse because of installation and maintenance of <br /> theimprove rotherright-of-wayuseheretoappliedforandfunheragrees <br /> � to remove same u on notice(rom the City and to replace public property <br /> � -�� - d�maged thereby. <br /> FINAL INSPE TION Date � <br /> Approved as Constmcted � <br /> Signature oi Ap can ` Date�� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN 180 DAYS OF DATE PERMIT IS IS ED ND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS UURATIGN. <br />