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I _. . . . . _ ... <br /> ApplicationFor ��—�� � ���� <br /> , PUBLIC WORKS PERMIT Date_ <br /> PUBLIC WORKS DEPARTMENT Public Works Permit a 9(p OB/ <br /> 3200 Cedar gtraet <br /> Everett,WA 98201 259-8810 <br /> �p POSTING >I'll\I t 1�'(3�uildingPermitq <br /> � 1 ., .,r��F <br /> TYPE OR PRINT ONLY Public Works Fee$�/? �v <br /> � L/IVT rIJ�3LL �//� 23i¢� Gt� �Vr2Err 9�203_�$'�-S//S <br /> Owner Mailinp Address City Zip Ph ne <br /> ��Ir�� .��!- 636/ c�. <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work QJ,U G 0 �jQ��,J � � <br /> � � ST .� �;�; b :.,�sb=?� ,,00N�:��, ,.,.;:. , <br /> , �, <br /> PFiOJECT ADDRESS(if known) S��J'r ��R� ��p �T��: { L �?�:,�� � <br /> +_;-�:�; _: �_..: � W <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: � � <br /> •Property Lines qutline and dimensions of all existin9 and proposed structures on the lot •Existing and proposed utilities O <br /> •Centerline of street •Indicate North 'Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITiONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance- phone 259-8810. <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and O <br /> Construction Standards and Specifications. <br /> 3. Call Locatfon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> / ' (/,St' SPnc�C� ��/� p vA.G . Co�Lpr � <br /> Tp�^ �Ji�p-a C�Oh/J�c_tic/� �h7�o Co,�c_/,6�:,ryh O <br /> S. /P�y,ot�c �" ���<<Ce Sio�cti<<�.E � <br /> af c�.�,����:�., <br /> �oi:�f — /�G /Ilo�` Tunr.e �. <br /> �O. l/SC So�/�/ SD�f 3S or Sche�'.�L ¢G /���G " <br /> llr�,�2�" Sic�i,J�L,� p�Pf <br /> �J ACKNOWLEDGEMENT OF CONDITIONS <br /> eY�L�' " '� The undersigned owner/applicant hereby agrees to hold and save harmless <br /> r�` the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for on�ction pa� � — causes of action ihat may arise because of installation and maintenance of <br /> ihe improvement or other righFof-way use hereto applied for and fun;�er agrees <br /> / / to remove e pon notice from tha City and to replace public property <br /> «i.:�-�G.�--- (/ l� damage ereby.; <br /> FINAL INSPECTION p e j �`n"v/ '� <br /> Ap{:roved as Constructed I <br /> Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUEO TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />