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� <br />�� <br />TYPE OR PFiINT ONLY <br />qpplkxtion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett, WA 98201 259-BB10 <br />1: �C. �1�ti �T <br />Mailing <br />?c Cc� <br />Date _ . �— s—'%6 � � - � ... - - <br />Pu6iic Works Permit N �� OV Z <br />Building Permit R <br />Public Works Fee S � <br />! �?�.'...G <br />Ph n <br />��.�L <br />>34 • �8>2 <br />-� � c-� <br />A licant Mailing Address City Zip Phone � <br />PP <br />Describe Proposed Work C <br />I iJL %i l ti �� I <br />��?/�'- �c � C�r�c -.:�,,m 1-Y-51 'ip %a—l-96 <br />�'r!o, �� <br />PROJECT ADDRESS (if known) <br />u—'-C•�l <br />t4�r�s' . 'v'��..rJ. 2=-/6 _ 5:;o:<i,�!c i;:��:�t_ <br />Attach four (4) copies o1 plans for proposed work • Draw to scale and note the following if applicable: <br />.•Property Lines 'Outline and dimensions of all exis�ing and proposed structures on lhe lot •Existing and proposed utilities <br />•Centerline oi street •Indicete 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 25f °810. <br />2. All work shall be performed in accordance wilh this permit and current ;ity of Everett Design and <br />Construction Standards �nd Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />� � � ! �f7c , /� %e; :-n rac� � C�%ilfi �'��cin+ C.- c'T�'_ Y <br />i .i� ` ,/ <br />D/,;iKGLCt G°r� S�cls �J �rc✓:...7' ✓rivji� 4ro✓�?C!. <br />,S COrSuI� L�.�i<<i irir Pa6Gi<. Gv'o.-.Es ������y<<y- C�i%�'n <br />//JSfclli�j' .�'�uSu�c , <br />�o. T�1is �ier��� /t �r <br />�uf. is �-e n�,.�461e . <br />7. <br />i�i�.e ��rc.. <br />Ci�e �� /���,.-r/� orCy� <br />O � �I�I ��Vl�f � <br />/.lJ,`i�n �/vSii?j � oicl . .'.ca.,f ��,lC .•,n;`.�� f/�� �oCla��i��� y1�` <br />� � fP <br />F� drtP Pouc� ot.t-� Z' <br />�fc� �' 2=r'-P757 /' `; -U�uS <br />' �W4 f[ii C a" M anQCr� �—.. ;r� ^ <br />��"_ 1 <br />. , , . / i�� • Of' On�' r,^.7rC /�Jn. i <br />. . . _ _ � ci_ n <br />i r <br />� � � The undersigned owner/applicant hereby agrees to hold and save harmless <br />n �)� �/ / ; /�. '�6 the City of Everett irom any and all claims for damages, costs, expenses, or <br />�" /� J� � /� � GY� - 0.h causes of action that may arise because o1 installation and maintenance of <br />provedtorCo structio (I ' �a�e lheimprovementorotherrighPof-wayusehe2loappliedforandtuAheragrees <br />� to remove same upon notice Irom Ihe City end to replace public property <br />damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed ��� ��7-��� �- / �' %� <br />SignaWre of Applicant Date <br />COMPLETION.TIH SD ERMIT MAY BE CANCELLEDTBYTHE CINIUPON �ANY SOTOPPAGE OF WI ORK ON THIS PROJEC O EER 90 �AOYS DULRATION`Y PURSUED TO <br />� <br />