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_ � <br /> Appiicalion Por .�� <br /> �i��� PUBLIC WORKS PERMIT Date_� o �-l�.R� �> <br /> `c PUBLIC WO�t(S DEPARTMENT public Works Permit H �D S� <br /> 3200 Cedar Sireet '��.!.I <br /> Everett,WA 98201 259-@870 Building Permit k <br /> `.7 <br /> TYPE OR PRINT ONLY Public Works Fee$ z p O'� <br /> �, <br /> ;;'. <br /> ��c�c.�; l�eooFu� ��12 ��-� 'ST U'� ��r q��2o� �-2� -?.�S- ��i� 5 <br /> Owner Mailing Address City Zip Phone <br /> ��ME_ ' <br /> ApplicaN MailingAddrass ,�I ��.�_ �-�- City Zip Phone <br /> Describe Proposed Work If�ED• LIl1K.. � 1.1C1�1 F UM �Ra*1T ' �R To � <br /> 51D��ALI', To P�4� irJD 'T6�5��J�. `1�ol.t. � EO � ctiF .D-'�'4� � � <br /> �D,c_k, vF M`� t�Usr C�4�ERE I �NZ.K.�� . �Upl)l �C� � DE �LE A <br /> V♦ <br /> PROJECT ADDRESS(if known) ��� 1 — �`f'�-57�: � <br /> Attach tour(4)copies of plans(or proposed work-Draw to scale and note the following if applicable: O <br /> •Property Lines "Outline and dimensiocs of all existing and proposed structures on the bt 'Existing and proposed utililies <br /> •Centerline of sireet •Indicate Norih •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMI7 CONDITIONS: Z <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. ?OLL FREE NUMBER 1-800-424-5555. ` <br /> �—, <br /> !. Fc.-rcc 2�o Be� c�s s1�ou��, vh as�7�ac�ec� Zjr,aw�ns � li <br /> �-�, ��YJCtX. �P(Y5� Oz�' F.,Gc' f'o 6? Lfz �{ O <br /> � <br /> ACKNObVLEDGEMENT OF CONDITIONS <br /> I The undersigned owne:/2pplican�hereby agrees to hold and save harmless <br /> ��j -3�J9 the City of Evere��from any and all claims for damages,cos�s.expenses,or <br /> �9'� causes of action ihat may arise because of installa�ion and maintenance of � <br /> A rovedf Con$in o/ Date � theimprovementorotherright-of-wayuseheretoappliedforandfuAheregrees , <br /> . � <br /> � � , � to remove same upon nntice from the City and to replace public property �, <br /> iJ��__ . �/ob dam ereby. '� <br /> FINAL INSr'ECTION Date <br /> Approved as Consimcted <br /> Signat f pf a t Date <br /> WOPK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN iB0 DAYS Of DATE PER�d1T IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO � <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DUMTION. <br />