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ApP�icaOonFar /j �j�_ /��— <br /> � PUBLIC WORKS PERMIT °�1e - :' `�� �� ) <br /> PUBLIC WOFKS DEPARTMENT x Public Works Permit k I "- G�� ��'� <br /> 3200 Cedar Street 7 <br /> Everett,WA 98201 259-8810 O a 2003 Building Permit F_��.5,�� � �C.-___ <br /> TO POSTING SEP-- publicWorksFeeS �' Zo "- <br /> TYPE OR PRINT ONLY <br /> RAL L 200zq I�T�P�, (,e� L Y4l4XCl/� `1g°3( �ZS-�a?Z-(o4� <br /> Owner Mailing Address ity Zip Phone <br /> 4 S�atE '� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 3� �K �r AP�►�r��3�G� 0� W <br /> �,w�R_.�t��.�R��.� I- <br /> - <br /> - � <br /> PROJECTADDRESS(ifknown) �7w ��`�8�� « � �� �� ��C � <br /> Attach tour(4)copies of plans lor proposed work-Draw to scale and note the tollowing i1 applicable: O <br /> •Property Lines 'Outlinc and d�mensions of all existing and proposed strucWres on Ihe lot •[xisting and proposed ulilities <br /> •Centedine of slreet •Indicate North •Show any proposed grading changes •Show measmemems � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All cails for inspection shall be made 24 hour�in advance-phone 25P-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of[verett Design and <br /> Construction Standards and Specificalions. <br /> 3. Call Localion Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. -- ` <br /> ♦r^ <br /> 4 /�-; �7�r �,�����z;;��Gl �_�I�„7 c�7t�E� �f-lrc�CX� . V/ <br /> . � O <br /> a <br /> � <br /> E <br /> ACKNOWLEDGEMENT OF CONOITIONS <br /> The unAersigned ownedappliwnt hereby agrees to hold and save hartnless <br /> -� :i � /� � 7 � ihe City ol Everetl irom any and all claims for damages,costs,expenses,or <br /> � causes ol action that may adse because of installation and maintenance of <br /> Appr ved tor Cons ruction Date the improvement or other right-ol-way use hereto applied br and furtheragrees <br /> •� to same upon notice irom the Ciry and to replace puhlic property <br /> /S� Kr , l/ ��dSi„i"� .'7 _ �,, vi�c amagedth eby. 5 � �� <br /> 1'� w <br /> FlNAL INSPECTION Date <br /> Appmved as Consiructed - <br /> Signature Appl ant ate <br /> WORK AUTHORIZEU BY THIS PERMIT MIiST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE GN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS URATION. <br />