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Application For <br />°V.. <br />PUBLIC WORKS PERMIT <br />Date <br />OL <br />PUBLIC WORKS DEPARTMENT <br />" <br />Public Works Permit If 9V�ois <br />Ind <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />Building Permit 0 <br />PASTING <br />350 <br />TYPE OR PRINT ONLY <br />o o <br />,Eublic Works Fee S <br />�T <br />�.y Cx � <br />X 1 <br />J O <br />CJ Iw <br />Cd <br />rIRST 6Ri'TIST affuRctl /Gl( PACIfir, <br />FUCA.0 <br />o/ .�S'i-91164 <br />Owner <br />Mailing Address <br />Ciro <br />¢Zip hone Z-706yC3'bo� <br />WF,ow k1fL5a V <br />/arc pAci�ic <br />a <br />Ef.�zpE , a <br />gFzoi zSSi-4t c <br />Applicant <br />Mailing Address <br />C J� <br />Zip Phone ^� <br />Describe Proposed Work E PLf1CF f}vi/ 9, PkC-X w/r/f <br />1 • t <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines "Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities <br />•Centerline of street 'Indicate North *Show any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed 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 />/ �orJF zoo Xe- c ohe IDar cL,p�hv✓¢d PLan <br />.S �9,ph� It fc Be /r�in..nuM of Z" cC4ss f8 � <br />0j,,C, Q" Ote, crvs,4Pal ros,'F-. <br />Approved f r ruction Date <br />AL NSPECTION Date <br />Approved as Constructed <br />TV <br />7 <br />71' <br />z <br />0 <br />W <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the C-ty of Everett from any and all claims for damages, costs, expenses, m <br />causes of action that may arse because of installation and maintenance of <br />the improvement or other rght-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 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 />