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� <br />� <br />TYPE OR PRINT ONLY <br />Appliwtior For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everen, WA 98201 259-8810 <br />T�i POSTING _ <br />T <br />Scf' 0 6 99G <br />oate / S SY6 <br />Public Works Permit # <0 9 ao z <br />Building Permit k <br />Public Works Fee $ _ —�-- <br />�n�a•Nnm 9S].7�6 �3:p�>34- �A>2 <br />Zip Phon <br />caL�. SeC-F <br />Applicant Mailing Adtlress City Zip Phone <br />Describe Proposed Work <br />� <br />/-4- <br />4 <br />PROJECTADDRESS(ifknown) g��y. 8%ZGS� ��lO��Z/6 Spo,KµAE Df1rd� <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the tollowing if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Exi;ting and proposed utilities <br />'Centerline of street •Indicate North •Show nny proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advanca - phone 259-8810. <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 �ocation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />/ i v� a �j � //L gi�.rn tl.f1C Gv! � • <br />O�f�Ler on Si�s f 7�.`.ic �Jnc..� Or v7�e/�- <br />�/'�r/Cn/ Oriv,y� 4rav�p, <br />.S COn, sc.l� Cu�ii� YSfe �6Lic Ldor�Er �ns���i, Ld/�'�� <br />//7SI�!!i�!� •�"LoSu.�c. <br />(O. T l.0 Pe'.i /+7Ir /✓' Tor Q7c' �/ %�Onf/J U/��r/ <br />6uf is �-a n e�✓adCe . <br />7 ClJ�lan GLoSin� ra�� �;`.�l�Cenf S�i4ll hoy%�y flie f'(Co��i�y: <br />Fn' dii�efc/ a ZS'9-97s 7 PvucE D�pt. -� �S�_agos <br />(�K�L'�i C�"�MqrtQ�� <br />W <br />� <br />♦�^ <br />V♦ <br />� <br />O <br />� <br />ACKNOWLEDGEMENTOFCONDITIONS � <br />The undersigned owner/applicant hereby agrees to hold and save hartnless 1 <br />the City of Everett from any and all claims for damages, costs, ezpenses, or <br />causes of action Ihat may arise because of Installation and maintenance of <br />ihe improvement or other nght-of-way use hereto applied for antl further agmes <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />�� �� /- �/-96 <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTCD WITHIN 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLE?;ON. THIS PERU!T MAY BE CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS FROJECT OVER 90 DAYS DURATION. <br />