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Date��t 9�j <br />Applicetion Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />MeiNng <br />Describe Ptoposed Work <br />Project Address (if known) <br />naaress <br />wencwonuv�n• ��f'4'� � <br />aieo. o.a.. <br />WOIK Worlu Fn <br />Tol�l Fee s <br />La�s 11pp1 FN P�q i <br />�f O <br />B�bm;a Due i � 1 / 4� <br />q9 t'tlari: <br />2ip � <br />Zip <br />J ��� iV1 <br />Attach four (4) copies ol plans for proposed work - Draw to scale and note Ihe Ioilowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ezisting and • Indicate North <br />proposed structures on the lot • Show any proposed grading chenges <br />• Ezisting and proposed utilities • Show measurements <br />rnone <br />PERMIT CONDITIONS <br />t. An caus tor inspecuon shau be made 2a hrs, m advance • phone 259�8810. <br />2. All work shell be pertormed in accordence with this parmit and current City ol Everetl Deel9n end Conatruction <br />S;anderds end Specilicetiona <br />3. Cell Locatlon Underground Service 4B hrs. before you dlg. TOLL FREE NUMBER 1•800-4245535. <br />�(. M.cp c;�.J sia-cet,5 c�ean at, a�l ¢,irnes. <br />(���,W( �-(�_ 4� 8- 93 <br />Approved lor Construction Date <br />o �il/� o/l C�io� / i 9 <br />F NAL INSPE TION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Sheet <br />Everett, WA 98201 <br />Phone: 259-8B70 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />The undersignetl owner/applicant hereby eprees to hold end save harm• <br />less the Cify of Everett Irom any end all cleims for demepes, cost& <br />expenses, or causes of ection that may arise because of in6laltation <br />and maintenance of the improvement or other right-of•wsy uae heroto <br />applied for antl further egrees to remove same upon notice from the <br />City and to replace public property damaped thereby. <br />���A'i �� <br />Sig re of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STA.RTED WITNIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DI� +GENTLY PURSUED TO COMPLETION. THIS PEHMIT MAV RE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.lECT OVER 90 DAVS OURATION. <br />