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TO POSTING Ju"''20°° . �� <br /> �; <br /> Appl�cetlon For Date� <br /> PUBUC WORKS PERMIT -' qq o8Z <br /> PUBLIC WORKS DEPARTMENT Puplic Works Permit A <br /> 3200 Cedar Street ±' � '��¢ <br /> Everett,WA 98201 (425)257-8810 BWlding Petmit M <br /> TYPE OR PRINT ONLY � f? �'' � Rublic N/orks Fee$ ZD <br /> • �-� �:. , . _ „ .-- <br /> R��k� 41a►+� P° P,t�x. ,��q �' �1�r�sv��I� �� �q s2�o <br /> 3� �vS3 3�48 <br /> Owner MailingAtldress� ;�.- �yP p�B <br /> :i <br /> Applicant Mailing Atldress �' � � �� Ciry -. �! .ZP Phone <br /> Describe Proposed Work 1 � 1 <br /> Iii <br /> � '� <br /> � <br /> � <br /> PROJECTADDRESS (if known) �Z +KVL W � <br /> Attach four(4�copies plans for proposed work-Draw fo scale end note the following If applicable: O <br /> •Property Lines •Outline and dimensions ol all ezisting and proposed stnrctures on the lot •Existing and proposed udlities ' <br /> •CenteAirre of street •IrWicate NoM •Show any proposad grading chenges •Show measurements <br /> DO NOT WRITE BELOW THIS LINE Z <br /> PERM�T CONDITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be pertortned in accordance with this permit and current Ciry 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 /> �/♦ <br /> 4, Gbh�� �p ��� -� �� �r�� �� ���a� Q <br /> a� I�. a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> G The undersigned owner/appllrant hereby agrees to IaM erq save harmless <br /> 3 3� the City of Everea from any and all claims for darr�egea,casq,ezpenses,or <br /> p i or n,, ion / e causes ol ac�!m that mey arise becauee of instelletlqi and maintenence ol the <br /> /1/ improvement a•olhe•�riphbof•way use herelo epplied lor and lurthor eg�ees b <br /> _�'!{�G �„l�.r�...- (� %Z3-17r rertwve same upon rnitice from the ciry and ro replece pub�b propeKy dam. <br /> FINAL INSPECTIUN Date ��� <br /> Approved as Construded , � �Q[� <br /> reo ae �'% <br /> WORK AUTFIOH�D BY THIS PERMR MUSi BE STARTED WIiHIN 180 DAYS OF DATE PERMR IS ISSUED/ND 7FEF�AFIER IS lOBE Ol10ENTLY PUR�J�70 <br /> CONWLE�ION.THIS PERMR MAY BE CANCELLED BY T}�QT'UPON ANY STIX'PAGE OF W�OPo<ON 1HIS PRQEGTOVEFi BO DAYS DURATION. <br />