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_ .-� <br />.. <br />_.._ , _ : <br />. �. .. <br />.. ` -- <br />oate � c''3 &6 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />_� ' "�C_�O.E'C7 <br />OWf1Ef <br />sA� E <br />Applicant <br />2ip <br />Clp <br />PuElic Works Permit • `� � — �^ �J <br />61EB. Dep�. e <br />Pu01it Woihs Fee <br />Talal Fee S <br />Less AOG�� Fea Paid S <br />Balante Doe <br />s 2a�� <br />..7� <br />Describe Proposed Work GL —� 7 �C'Of.CF'.�. % Tn S•�/-+v�T l�9.v.0 <br />f�iYOM Sc/�ivf/b /NTG C9.P/�G.e'T ��9.E'.CiitlG A.e iy <br />Project Address (if known) `S�mF <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as'� <br />� Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities � <br />• Certerline nf ! Q <br />• Indicate North ��// ��`/ G 1 <br />• Show any proj �, 7 <br />� ;,� i,lJ <br />• Show measurl �: )�F7` �, <br />.�� <br />N <br />PEFMIT CONDITIONS i � <br />7. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 : �/O � , <br />2. All work shall be perFormed in accordance viith this permit and current City < {�� � <br />Standards and Specificalions. � <br />3. Call L�•�.alion Uaderground Scrvice 48 hrs. before you dig. TOLL FREE NUI1.__.. ._. J <br />� �c�c.��',c�f/ �/o'r :o Cxc��� �2 � in/ %�,c,li.s�i.— <br />� ��,�.�..r�lrs'9� <br />.S- /l�'oCKc�"�'� iU BE' /�oriEp <br />/F �rry..✓r.q•,�c.✓c6 0�.� ri� <br />/N T/fE' %/-'SA /S I.i/fEKfE�2E� <br />/�C:e CA.t'.e C29�✓F�%:D <br />���f'3--.� ���__._ 7��� <br />Approved for Construclion '� <br />����/� -!J -�� <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98207 <br />Phone: 259•8815 <br />�i Ol.�/ir/E.�S G�-C�ENL � <br />c�r� ��/9r<<,e /�79i�+/ <br />��Ty 09/17/86 8:389M I <br />/ <br />DPT.^cO f^cO.� <br />CHECY. St0.00 <br />� �5 <br />��� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />w � <br />� <br />� <br />O <br />a <br />The undersigned owner/applir,ant hereby agrees to hold and save harm- <br />less the Cily of Everett irom any and all claims for damages, costs, <br />expenses, or causes ot action that may arise because ot ;nslallation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrPes to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />%;% -.%� <br />1 , !-1/ //��" <br />/'r � �� /A l . /'—i/"il � <br />Sk�rrSCure. 01 dpplican Date <br />VJORK AUTHORIZED BY THIS PERMIT MUST bE STARTED WI"fHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />