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Appl¢ation For �� '� <br /> ���� PUBLIC WORKS PERMIT oate���LoL� 7—�-�-- <br /> PUBLIC WORKS DEPARTMENT Public Works Permit q _��'j/3/�_ <br /> 3200 Cedar Street � ( <br /> Everetl,WA98207 259-8810 <br /> ���7 �Z��� Building Permit#__ ___ <br /> T^ POSTlNG __—.— o� <br /> 7YPE OR PRINT ONLY U PubP-.Works Fee S Z� <br /> �¢r' �v�(/!vi D � /,� �vV�y�66-✓. �„LP�dS7D� ! ���C '�L3 2��• ,�z <br /> Owner Mailing Address City �Zip Ph <br /> ��Q - <br /> 4pplicant Mailing F,ddress City � Zip Phone <br /> Describe P•e;;�sed Work _�_��_-�,� i.���s/ �.,-r.� �.�.�.ar� .Cp�cl/co � <br /> �S/S-�,c� _ iZc�z— 9 Z-2� �.. <br /> � <br /> PROJECTADDRESS(ifknown) _�{�+S�S �/� 2[ � � <br /> Attach four(4)copies ol plans for proposed work-Draw to scale anA nute ihe lollo�.ving it applicable: � <br /> •Property Lines •Outline and dimensions ol a�l enisting and proposed structures on ihe lot •Existing and proposed utilities O <br /> •CeNerline of street •Indicate Norih •Show any proposed gratling cl+anges •Show measurements � <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 /> �. �Q� �-l/V'U/CA_ /�^i C(�j S!`'o� .rf' Z /� O <br /> > > <br /> s �.,..� 5��6 � c�� s�- Ja r, ��z, ��y a <br /> ACKNOWLEDGEMENT OF WIJDITIONS <br /> The undersionetl ownedappiicant hereby agrees ro hold and save harmless <br /> _7 / — the City of Everett Irom any and all cl.'vs for damages,cosis,expenses,or <br /> �� d causes of actinn that may anse because of installation and maintenance of <br /> Appr�4or C r n 7 D ! <br /> � Ihe improvement or other right-of-way use hereto applied for and further agrees <br /> �� to remove same upon notice Irom the City and to replace public property <br /> .� — /._ a�-f'� damagedthere6y. <br /> FINAL INSPECTION Date <br /> Appmved as Consiructed ! n <br /> � /� T <br /> S� na urc ot p liea ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEiION.THIS PERAIIT 41AY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OP VJORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />