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Date-"- ') 1 i 1„ll "9 - Public Wo,kP41M Ais <br />Application For Bldg Dept <br />PUBLIC WORKS PERMIT PubTkof ;Fee -7 <br />Les. Appl. Foe Peld 9 <br />Print or Type Only BeienceDue B �� <br />i CZ o6) <br />SQL„� CQYr), 2cl C-Il ntI /I✓Q- (J. S z <br />u 1 /e GO SPa jd r_ 2,P/-d'70/ <br />Own r Malling Address City ,: zip j1 Phone <br />Fc I' q'... yLa;.-A -J= ` rr�Se <br />Appllcanl M Iling Address City % Zip Phone ' <br />Describe Proposed Work r- , nr <br />Project Addreas(if known) IS7 S' — T ry" <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />Proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.8815. <br />2. All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cali Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800.424-555,55. <br />'� �(J!j /1�'Q/il� �Q ' /'+ � l.i--�-%lIIL7i � i"e�j' e-' "� � �1P/ � • -- <br />SZ/hC S/,s/16./0?r -/-V & <br />-PrJ�r�c�+t 4 14-e- LUo� lassrrlrte�cC <br />A <br />Approved as Constructed) U <br />everelt PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ul <br />ca <br />O^ <br />Z ' <br />O ' <br />V♦ <br />O <br />do <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herebyagrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and meinlenanee of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property -damaged thereby <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON T- <br />PRO.'ECT OVER 90 DAYS DURATION. J <br />