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qpplicnlion Por <br />PUBLIC WORKS PERMIT <br />PUBLIG WORKS DEPARTMENT � <br />3200 Cedar Strcaet " <br />Everen, WA 98207 259-8810 <br />TYPE OR PRINT ONLY <br />l�y��- �A� <br />Owner <br />f/� ,�f <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />8� � y X�� i c�2 �.�+� <br />i <br />ddress City <br />�I � <br />,��- ; <br />� � <br />Date _ � — <br />Public \Vorks Permit M yl/�1/�� I <br />Building Pe;mit N <br />Public Works Fee $ <br />W ' <br />2ip <br />si�'91� � <br />2 oN k����_�. <br />AtWch tour (4) copies of plans br proposed work - Diaw to scale and note fhe tollowing il applicable: osed utilities <br />•Property Lines •Outline and dim^nsions of all eaisting and proposed siructures on the lot Existing and prop <br />•Centerline ol street •Indicate NoAh •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 ho��s in advance - phone 259-8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and <br />Construction Stanciards and Specifications. <br />3. Caii Location Underground S,��,; B hrs. before you dig. TOLL FREE NUMBER 1-800-423-5555• <br />4. %'�ll 33�1-74�-� �s�t�^ P✓zor tU �� �rr� cD,,c�• <br />(1�' ZS?-8810 ��" � �� �� �L,al'" <br />, -ti <br />���(/p�, 7 .� 9� <br />Ap oved lor� n!__ _ D e <br />/ � (�,,-r,,.,-- 7- 3<-fe <br />�`� ^�C(,� Date <br />FINAL INSPECTION <br />Approved as Constructed <br />W` <br />i <br />�/� <br />V♦ <br />m <br />O <br />� <br />� <br />O <br />Y/ <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everefl fmm any and all claims tor damages, costs, ezpenses, or <br />causes of action that may arise because ot installation and maintenance of <br />the impmvement or other right-of-way use hereto applied for and fuAher agrees <br />to remove same upon notice irom the City and lo replace public property <br />damaged thereby. � � ��� <br />SignaWre oi Applicant � <br />COMPLETION TIHES P RMIT M11 YRBE CANCEIIEOTBYTHE CITYIUPON ANY STOPPAGE OF WORK ON THIS PROJEC OVER 90 DAYS DULRATION.Y PURSUED TO <br />