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Date ���9 � Public Works Permi��g � 7 � <br /> Appl{ca�ionFor Biep.Dep�.• �-3� �-2G79 <br /> PUBLIC WORKS PERMIT PubTOIeIFeeFee S j.��; , r, o <br /> Less noo�Fee Ps��a S <br /> Baienca oua S a�' O u <br /> Print or Type Only ����,r <br /> �rNeo t7'mmc- �/2dlCE= .�/S //�`� � c` GtJEkFt'T 9d'r�ey! .jS3,�5yC37 <br /> Owner MailingAddiess City Zip Phone <br /> Applicent Mailing Address City �ip Phone <br /> Describe Proposed Work �ff?Sr�UC� �✓��J ����1�_ ' <br /> p /, ,, W <br /> Pro�ec�Address(ifknown) ^� / V/e'"� !/l/a ~ <br /> Attach four(4)copies ol plans for proposed work• Draw to scale ard note ihe follow' g as applicable. � <br /> • Properry Lines • Cent ine of street (!1 <br /> • Outline and dimensions of all exis�ing and • Indicate North V � <br /> proposed siruc�ures on the lot • Show a�y proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOV�THI."i LINE O <br /> PERMIT CGNDITIONS <br /> i. All calls tor inspection shall be made 24 hrs. in advanr,e•phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with ihis permit and current Cily of Everett Design and Construction <br /> Standards end Specitiwtions. <br /> 3. Call Location Underground Service 48 hrs. before�ou dig.TOLL FREE NUMBEe? 1•800•424-5555. � <br /> 4. Y1 t' -F�+P_ -�r�r�,1� �CJ -Fte{— o� l-l+� G1f.VPwn�l � <br /> w........�n w. � 1 { <br /> Y��U�� �OC �A�/ C� �W �1�\.�.�.�M11C �.tV :�JC1 �i.G�ln� Vv��V <br /> I <br /> �on ��.,R� Or- s�.:��,P�v �. <br /> � <br /> O <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Ciry ot Everett from any and all claims for damages, cns�s, <br /> expenses, or causes ot action that may arise because of installa�ion <br /> � �� //—/J= 83 and maintenance of the imProvemeM or other rigM-of-waY use hereto <br /> applied 1 r ard further agrees to remove same upon notice irom �he <br /> ed for Constructlon Date City an to replace puhlic pro ry damnged there6y. <br /> � /� �.L� 7 s 8Y — aP.r�f�LL Z. � y '�dJ'— <br /> i, � <br /> FIN SPECTION Date <br /> ppproved as Conslructed Signature ApplicAfSt Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOHIZED BY T IS PERMIT MUST BE STARTG� WITHIN <br /> 180 DAYS OF DATE PERM T IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CeAar Street BE DILIGENTLY PURSU[D TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED EiY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />