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� � ( Pl.t���-UD�o j <br /> Applicntion For <br /> PUBLIC WORKS PERMIT °a'e '>`�/� � <br /> PUBLIC WORKS DEPARI'MENT Public Works Permit# _�Z 31 <br /> 3200 Cedar Str=et <br /> Everetl.WA 98201 259-8810 Building Permit N___ <br /> � <br /> TYPE OR PRiNT ONLY Public Works Fee$___ <br /> /',�'q,,, / �03 ZZI-�i5" 7 j <br /> pW���V� V v MailingAddress ��� Gity Zip Phone �a <br /> yzs yg,-��.�� <br /> ��woo� S��c /7y�s� ���1/�sc ��»�;�r�.����9d�z <br /> Ap icant--� MailingAddress , , City Zip Phone <br /> � F7-// /L / /��"f' O �I� � S L <br /> Describe Proposed Work L�� � L/v W <br /> //�> '�' �r� ,a�s� �,��.s�� // l��,q�e'nrhe�e� �/l2p -- � <br /> � '�i ��/ ,a�n � A-�, � h (Z��Grt a� � � <br /> � / � yZs' 3� ��-�—G y� v♦ <br /> PROJECT ADDRESS(if known) ��2� �v/��v< �'G �tc�cp .�/C�s�'�''' <br /> S,rdc�' �-H�` � <br /> i�ttach four(4)copies of plans for p�oposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines •Outline and dimensions ot all ezis�ing and proposed sirucWres on ihe lot •Exis�ing and proposed utilities <br /> •(:entedine of street •Indicate North •Show any proposed griding changes •Show measuremen�s � <br /> DO NOT WRITE BELOW THIS LINF � <br /> PFRMI i CONDITIONS: <br /> 1. Ali calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. Ail work shall be per(ormed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call L�cation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> '�. Rr�c�►� �i��ny ks-� SfdP(� ��o O <br /> a <br /> ACKNOWL[DGEMENT OF CJNDITIONS <br /> —���'�� g 1z y� The undersigned owner/applicant hereby agrees to hold and save liarmless <br /> the City of Everep from any and all claims for damages,costs,expenses,or <br /> causes of action that may arise because of installation and maintenance of <br /> Ap m�edforConstruction �a�e iheimprovementorolherright-of-wayu;eheretoappliedforandfuAheragrees � <br /> �i •- �/ � C to remove same upon notice from the City and to replace public property <br /> ,(]' /�C((Lt ��'l'G[.�k^� ���(7 � /'� damaged th by. <br /> FINAL INSPECTION Date L^,��6�" �J y'a✓ <br /> Approved as Consimcted /�-'/ 1 —TB <br /> ' nature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 7a0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE D�LIGENTLY PURSUED TO <br /> COMPL�ION.THIS PEPMIT MAY�E CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br /> . <br />