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I �i <br /> , , - I <br /> Application For �, <br /> Date 03-2C7-9�o <br /> � pUBLIC WORKS PERMIT �/ /��� _ <br /> PUBLIC WORVCS DEPARTMENT <br /> Public Works Permit N _.�� <br /> 3200 Cedar Street i <br /> Everett.WA 98201 259-8810 Building Permit N -- �I <br /> Public Works Fee S � <br /> TYPE OR PRINT ONLY <br /> ��ss s.e. E.��� 41a °l�3zo8 3d-8~53�4-aH <br /> (��/(JL�.Ef� 1092D ICTIF4 L7e• Phone Zq4-l�g33�- � <br /> Mailing Address ���Y Z�P ' <br /> Owner !i <br /> �� Mailing Address Ciry Zip Phone I <br /> ANplicant <br /> -, 30�' �.}���} �a Fr�ca Was ���-r z �lv_s � <br /> Describe Proposed Work ��`����— <br /> �a o iT41 So-rt� '�P ot,lN�`-• cnNs�T. e��� �"r � <br /> -rN-is �r�a. co�N s� us� t��-M ��-r�l n.�zovaL�Z ►.lo� t�tcF. -ra � 'I <br /> aPPi-Y Fa� Tti+�s P�er�.�-r-. �4 <br /> PROJECT ADDRESS(if known) �p"F'�� m <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note Ihe following if applica6le: O <br /> •Property Lines 'Outline and dimensions of all existing and proposed simciures on the lot •Existing and proposed utilities <br /> •Centerline ot street 'Indica�e North •Show any proposed grading changes 'Show measuremenls � <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 performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> ¢ `YJ4�r. T,�n � 7T D� C�c'G- �ancc �i^an� f.� � 07� � ;I <br /> �.� c� fa �o c,F o F s.�✓a«<<</�.. O j <br /> � i a � <br /> /U9z4 � /09 ZO I N�— i <br /> I " __ .. I <br /> � _ ._,...r � <br /> �c � , <br /> � <br /> �Z�f; MJ�i✓!Um � <br /> I _ <br /> $i U=G✓Ac% I <br /> <ia'`noz� ST.�<:E%. <br /> �/ -- ACKNOWLEDGEMENTOPCONDITIONS � <br /> The undersipned owner/applicant hereby agrees to hold and save harmless <br /> � � th^City of Everett from any and all claims for damages,costs,expenses,or � <br /> causes of ac:ion that may arise becaus cf installation and maintenance of <br /> edlor-C nsimction � ale theimprovementorotherright-of-way heretoappliedforandfaAheragrees <br /> � � to remove sa upon notice fro e City and to replace public property <br /> �� �� D ��� damTged 1 r <br /> / � <br /> INAL NSP�C iN� Date� � <br /> Approved as Constructed �– �—� 3 av-y� <br /> Sig tu f Ap icani Date <br /> COMPLEfION.TIHIS P RMIT MAY BE CANCtL EDTBYTHE CITY IUPON ANY SOTOPPAGE OF WORK ON THIS PROJEC OVER 90 DAOYS DULRATIONLY PURSUED TO <br />