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Appiication For Date � �� 9 --- / <br /> F'l1�LIC WORKS PERMIT public Works Permit M ��i z� � - <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett,WA98201 (425)257•8&S� Q � � Building Pertnit# ���� - �p� <br /> P` � <br /> TYPE OP PRINT t�NLY . ..STI N G Public Works FeP $ _ O� _ <br /> M/kF os�KF2 "L e12 f� -Adt�lvlL l✓bY Evt� v,l_ S�y'2a y ��1 7/y-/2y�q <br /> Owner Mai!ing Address Ciy p Phone <br /> i^ � /T/l�'P �C /¢�O ✓� — — — <br /> Applicant Mailing Addi�ss City Zip Fhone <br /> EX. T/.V � <br /> Describe Proposed Work �a �p� T� / � ^ <br /> � . <br /> � <br /> V/ <br /> PROJECT ADDRESS (ii known) � $�• �" � y-c . W• EUe W <br /> O <br /> Attach four(4)copies plans for proposed work-Draw to scale and note lhe tollowing it applicable: � <br /> •Property Lines •Oulline sad dimansions of all existing and proposed structures on tha bl •Ezisting and proposed utllitles I <br /> •Centedine�i street •Indiwte North •Show any proposed greding changes •Show measurements � i <br /> DO NOT WRITE BELOW THIS LINE ' <br /> PERMIT COiJDITIONS: O <br /> 1. All calls(or inspection shall be made 24 hours in advance- phone (425) 257-8810 <br /> 2. All work shall be peAormed in accordance with this permit and current City of Everett Design and � <br /> Construction Standsrds and Specitications. <br /> 3. Call Location Underground Sarvice 48 hrs. before you dig.TOLL FREE NUMBER 7-800-424-5555. /A <br /> V♦ <br /> 4 TL,,o� �C��B(-F 5�.+�uu� C�E. Dis4+�aRG� 7'o noWuSPo�r, INFi4''�tAZ�u O <br /> D�S(�tS�oN SYS'T&,+-1 0�1'i�+Ni[n �9Nn GM{t>iCuc>�p R5c C!�' Sr�l+Vp�r Ii <br /> �p (,,1SP�e7<oNs l��"GSTBO L�t <br /> K,q.• ����:,_;�, <br /> 7�1�'co wt�. �o.00 <br /> '].l��l <br /> . IJ <br /> .L.. , �.�,- �:. <br /> �'t3/ h ACKNOWLEDGEMENTOFCONDITIONS <br /> � The underelgned owner/epplicant hereby agreas to hoid and save harmless <br /> Gf'�i?�5' the Ciry of Everett from ery arW all claims for demeges,costs,axpnnses,or <br /> ��� causes ol action ihat ma arise because of Installetion and maimenance of the <br /> p e r ons ruc ion 15aF� Y <br /> improvement a other right-of-wey use hereto epplied for and further agrees lo <br /> remov e upon n e from the Ciry and to replace publ�property dam- <br /> aged <br /> FINAL INSPECTION Date � y � �� <br /> Approved as Constmcled <br /> igna ure o �p� n a <br /> WOHKAUTFIOR�D BY7HIS PEFlMfT MU6T 6E STAHTEU WfTHIN 180 DAYS OF DATE PERMfT IS ISSUED AND TtIEREAFfER IS i0 BE DILIGENRY PURSUED i0 <br /> COA�PLEf10N.THIS PERIu�T MAY BE CANCELLED BYhE CfTY UPON ANY STOPPAGE OF WOfiK ON iHIS PRO,IECTOVER 90 DAYS WRATION. � <br />