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���,` . • Appliwtion For �`� <br /> PUBUC WORKS PERMIT °a'0—'r� 9 <br /> � LIC WORKS DEPARTMENT Public Works Pertnit p /l0 '�f.�S <br /> � 1 a � 3200 Cedar Slreet <br /> TO POSTING ��r Wqg8201 259•8810 Building Pertnit# <br /> TYPE OR PRINT ONLY Public Works Fee$ <br /> ao� <br /> a ,y,�Sc, <br /> Jf1m �S G4 FF�y P o F.tcar ii o z F_,,,�� ,,,,,� 9a�p6 3s 3- Q3�� <br /> Owner Mailing Address City Zip Phone <br /> SL4 ✓�.E. <br /> �� O'•e 4 ci.av co Ov doX 22 Y3 E�.r�ee� ..�.�v f7so3 SS3-d1iS"-3 _ <br /> Applicant Mailing Address City Z�p Phone <br /> Describe Proposed Work Tivt�il�� S4TFG� « c.-..c✓ sbw.� s��� i W <br /> OR��'�✓as e SS si�'s_ Oc-+'ici <br /> i o :.' sT.p �� ^ Onr .:� � <br /> — ^ V♦ <br /> nSf-�LL C s cn ra7`� �o� Lor�.�cc�' 7�'o Ci r'�e��a c • <br /> PROJECT ADDRESS(if known) So�3- 23"=�A✓c� �- M <br /> Atlach fow(4)coples of plans Mr proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br /> `Centerline of street •Indicate North "Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELONJ THIS LINE � <br /> PERMiT CONDITIONS: <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and 5pecifications. <br /> 3. Call Location Underground Service 48 lus. before you dig. TOLL FREE NUMBER 1-800-4245555. � <br /> �/ <br /> O <br /> 11/1�/9E 11��4AM OOOR#Bb3 �'-' <br /> i <br /> �lOD096425 <br /> OTNEF 52Q.0� <br /> C!'•ECf; �20,0:1 <br /> J � ACKNOWLEDGEMENT OF CONDITIONS <br /> ���� /�6 The undersignzd ownar/applicant hereby agrees to hold and save harmless <br /> �� �z the City of Everett from any and all claims tor damages,cosis,expenses,or <br /> a�� causes of action that may arisa because ot Installation and maintenance of <br /> Approv rConstNclio theimprovementorotherright-oi-wayuseheretoappliedforandfurtheragrees <br /> �+ � to remove same upon notice from the City and to replace pu6lic property <br /> �'� /_ 1 Z-9 7 damaged thereby. <br /> FI1P INSPECTION Date / <br /> Approved as Constructed �"����� /�_l�_q� <br /> / � o Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE�WITHIN 180 DAYS E PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY BE CANCELL[D BY THE CITY UPON A OPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />