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... . Date �//e/ 99 / <br /> Applicatbn For -��T <br /> � PUBLIC WORKS PERMIT public Works Permit N 99 26a <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar�treet Gq q o,q� 6 � Q <br /> Everett,WA 98201 (425)257-8810 Building Permit A <br /> " ` �OSTING �R z � Zoo� <br /> TYPE OR PRINT ONLY <br /> � '� ! —�— Public Works Fee$ <br /> ti1/Kr CoAAC�R i2Bre - �tr�>.r � awv �r`�cF� u�f� 98zov ��) 7�y-izo8 <br /> Owner Mailing Address Ciry Zip Phone <br /> _ Sif7't�l /�S i9�� � ' <br /> Applicant Mailing Address Ciry ZiP Phone <br /> Describe Proposed Work Re �� ��rt � � N �'" � � <br /> I"' <br /> � <br /> � <br /> ��,,.' 2 �,� . r..i. �ii � <br /> PROJECT ADDRE:SS (ii known) ���� —' O <br /> Attach tour(4)copies F''�ns br proposed work•Draw to scale and rate the foilowing if applicable: � <br /> •Property Lines •Outline and dimensions of ali existing and proposed structures on the bt •Ezisting and proposed utilities <br /> •CenteAine oi street •Intlicale NOM •Show any proposod grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: O <br /> t. All calls for inspection shall be made 24 hours in advance- phone (425) 257-8810 <br /> 2. All work shail be performed in accordance with this permit and current City of Everett Design and � <br /> Construction Standards and Speci(ications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> 4. �N� �koM RvoFS 5flou�o B� DtScH�4Rv�p To aooF dow�LS'Povl O <br /> I/��jC,7RA7ro.cs�DISV`kSiu�/ SYll�M DIaS�C�„/�n RnlO GvNS7k"�TS� / `�' A <br /> li� <br /> G�Ty- oF Ev�:.rr St�l�n�1. <br /> �✓D l� S7 '�T/o�S wE�a� ����. <br /> �� i <br /> /; 31i`I 7� !�'p0 <br /> l�I ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applirant hereby agrees to hoW and save harm�ess <br /> � R �3 �' the City of Everett from any and all claims(or damages,costs,expenses,or <br /> causes of actlon that may arise because cf installatiun and maintenance of the <br /> r or ons ruc wn a e improv6ment or other rightol•way use hereto applied for end further agre»s ro <br /> removx same apon the Ciry and to replace public property dam- <br /> aged t <br />� FINAL INSPECTION Date � � <br /> Approved as Consiructed — <br /> igne ure o i fl e <br /> WOFiK AUT}10R�D BY iHIS PERMR MUST BE STAHTED WfTHIN 1B0 DAYS OF DAiE PERMfT IS ISSUE�/WD THEPFAFfER IS TO BE DIL1C,�'rlTt�a1RSUED Tq <br /> CDMPLETION.THIS PERMR MAY BE CANCELI.ED BY TI1E CRY UPON ANY SNPPAGE OF WOP!<ON TIiIS PRQIECT OVER 90 DAVS IX1RAT10N. <br /> —— <br /> -- . .. ._---. � <br />