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_ ro <br /> � C_.: <br /> Applicalion For �. <br /> PUBLIC WORKS PERMIT � ' od�e <br /> PUBLIC WORKS DEPARTMENT � Public Works Permit q � <br /> 3200 Cedar Street ��i <br /> Everett,Wq 98201 259-8810 � <br /> Bullding Permit k � <br /> TYPE OR PRINT ONLY Public Work�Fee$_�� 7� <br /> F'�i�: ;:; '._: ;.. „y �� <br /> P N �+�aNs���- ►��as ��om-�tre���kivY�l�.v �3o-�-eQ wtig8o�� <br /> Owner Mailm�Address ^ City �— Zip / Phone Y�3�� <br /> � � <br /> ?�/�n� L, greske, QE 130Cb I�t�,r/ 4'�1.5. �ref�� 1q/}� 48.204 425�356 27GG <br /> Applicant Mailingqddress a, Cjty��, �=� Zip Phone <br /> c _ ... �:. �.., <br /> DescribeProposedWork CIeC7Y'l Gru.�rl��� � 7'ES_Td, �� � <br /> �Y1S'F((a�r`�11, 1�E� �u��'Qnf �ns('41�a�'roh � <br /> Q '�' <br /> PROJECTADDRESS(if known) ' �O� v{� J� �yere� l�/f} q8� � <br /> Attach four(4)copies ot plans(or proposed work-Draw to scale and note the following if applicable: � <br /> •PropeAy Lines 'Outline and dimensions of all existing and proposed structures on the lot •6cisting and proposed utilities O <br /> •Centerline of street "Indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELpW THIS LINE � <br /> PER�IIT COfJDITIONS: � <br /> 1.Ail calls for inspection shall be made 24 hours in advance-phone 259-8810. <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and o <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> �- �'..�,, ��r��� ,�f F" <br /> � <br /> O <br /> a <br /> l`�►`li,e'`Jay ir� «C � �' �� 5��� �n.as � L <br /> rtU(, S.�e,,, (�`cu�d wt1� Cw-b � 6.,.ff-e-� u r�d s 1 r.�.u-Ql , <br /> ��j�. /(.z�-�o � <br /> /' ACKNOWLEDGL-MENT OF CONDITIONS <br /> �� The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � . �� � G�� the City of Everen fmm any antl all claims for damages,costs,expenses,or <br /> Aupr vad� ruction--� a�e causes of action that may ariso because of installation and maintenance ot <br /> � ihe improvement or other right-of-way use hereto applied for and faAher agrees <br /> to remove same upon notics from the City and to replace public pmperty <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> �G' � � 6 7��� <br /> y a�m i an Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS�SSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT FAAY BE CANCELLED BY THE CITY UPO�ANY STOPPAGE OF WORK ON THIS PROJECT OVER 9C UAYS DURATION. <br />