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ApplicationFor i;� Date_�j�� � / CJ <br /> � PUBLIC WORKS PERMfT <br /> PUBLIC WORKS DEPARTMENT Public Wo�ks Pertnit N � O <br /> 3200 Cedar Street <br /> Everett,WA 98201 259•8$10 <br /> Building Permit M <br /> � 7a <br /> TYPE OR PRINT ONLY Public Works Fee$ ��9 <br /> _ ":i <br /> ��'G I!l � �( i�,no.t �7/� '�6�(� •S l ,Si�' CJ`KY-/C.E �l/,�ipE/�/4.70 ��-�I� 3 S�-7�b0 <br /> Owner Mailing Address City Zip hone <br /> `-�R M� , . . . . <br /> Applicant MailingAddress� �. . Ciry Zip Phone <br /> Describe Proposed Work S., sj>a/l Spr�a.c �K Tpaiiv., FRex., /4TM .�w �� ■ ■ ■ <br /> TC .^. in cZ RCriCe%55 / T� � <br /> � <br /> PROJECT ADD��SS(if known) ����Q — /Q�h�/,� �f� � <br /> Attach four(4)copies n!plans tor proposed work•Draw to scale and note the following'rf applicabie: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures c�the lot •Existing and proposed utilities <br /> •Centerline of street •Indicate NoAh 'Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW'fHIS 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 curcent City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424a555. � <br /> � y.��- ��r�- ��1� c�! �� �o-�- 9e O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undorsigned owner/applicant hereCy agrees to hold and save hartntess <br /> �� ,� /v the City ot Everetl from any and all claims tor damages,costs,expenses,or <br /> Ap ed lor or}a ction " � te�i�� causes of action that may arise because of installation and maintenance of <br /> ��,,(!"/"/////���� � theimprovementorotherrighFof-wayuseheretoappliediorantlfuAhar rees <br /> '°�� �remove same upon notice tiom tha City and to replace public property <br /> Lf.�,.�,u,—y/ a ��—p5 dam gedthereby. � <br /> FIN!{ PECTION Date <br /> Approved as Constructed , � [�� <br /> s.+�i "��/1S <br /> Sig ure piicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DIUGENTLY PURSUED TO <br /> COMPL�ION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />