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� � � _. <br /> Apolication F� �' <br /> � PUBLIC WORKS PERMIT Date 'r� %� <br /> .�s�i a <br /> PUBLIC WORKS DE�RTMENT Pubtic Works Permit p /� �7s <br /> 3200 Cedar S et <br /> Everetl,WA 98201 50-8610 Building Permil k <br /> g — <br /> IYPE OR PRINT ONCY, n�STI NG ��� 2 Q �96 � � Public Works Fee S � �U�' <br /> �p/ ---____. :: ./� <br /> �C'/3T l��/7��IP4C��/O.� i v SD���UL't�'Oo�Od' �i'PR'`'�� �G��03 �2C613S3 - �y.� <br />� Owner Mailing Address �� City Zip Phone <br /> vy,��csiAr nR�co�/•<;r s.-�� � � <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work v��i A e ti� . ■ � ■ <br /> ^ C n¢ G C' Jfa /n . � <br /> � <br /> PROJECT ADDRESS(if known) �S� —' la �hF,'�� -S�- � <br /> Attach tour(4)copies of plans for proposed work-Draw to scale and note the following if applicable: � <br /> •P�operty Lines �putline and dimensions of all existing and proposed structures on Ihe lot •Existing and proposed utilities O <br /> •Centerline ot street •Indicate Nohh •Show any prcoosed grading changes •Show measuremenis � <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. O <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards cnd Specifications. <br /> 3. Cail Location Underground Service 48 hrs. be�ore you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � KYS�ort S�ol t�•a C,E'/ Crr� �'�v�1'�r 4 ho� -r7`'rc�"7`' � <br /> f� o��lira� roho�z�ioh , O <br /> S �eP G'�7�f.Sf�ee�S �'�e �i, ct1� �.LC fi�'.� 1i <br /> �i , /��C �7'i47�critL COhncGj',on �O C'47���� L7C.Slh <br /> 7r fx a�Pro✓E�6�, f�e C.�li �c�lli� wor.Fs ThtpeC'i`or <br /> 7 �?LeT Lu��i �U6LiG l.C/Or�S �hsPeG�or Gi, .Si7� <br /> UC�.�r�e /�cz�ihnin� LC�'J�"�, ,� <br /> :I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrecs to hold and save harmless ' <br /> �� �� 5� ,bL the City of Evgrett from any and all claims for damages,wsts,ezpenses,or <br /> QQQ �-- causes of action that may arise because of installation and maintenance of <br /> Approved rCon t ction Dat theimprovementorotherright-of-wayuseheretoappliedtorandfurtheragrees <br /> / to remove same upon notice from the City and to reptace puhl�c property <br /> `�, � �/}�lC�'G damagedthereby. <br /> TIYAL INSPECTIO �te <br /> Approved as Constmcted <br /> -C.L�'t�`�— O�-OG-� <br /> ' Si pplicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 78D DAYS OF DA P MIT IS ISSUED AND THEREAFfER IS TO BE OILIGENTLY PURSUED TO <br /> COMPLETION.THIS PE�MIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />