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, ApplicationFor /Z/�/�� / <br /> PUBLIC WORKS PERMIT Date � <br /> PUBLIC WORKS DEPARTMENT Public Works Permit k //��BZ <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8870 guilding Permit p� <br /> 7 O�U <br /> TYPE OR PRINT ONLY Public Works Fee$ -� � <br /> B� <br /> �A�cEss `14�D EuFacc-�rt,�v� c✓iy ��0�=�1 <br /> Owner � Mailing Address City Zip Phone <br /> ��c[s �o��sr�crra✓ �,.c= � � ss,�,� 5"e�t�% 98/a'/ �x�� 3y3-7BBB <br /> Applica�t ' Mailing Address City Zip Pho c <br /> Gs:,crihe Proposed Vb'ork /i 5"'�94 , y� �� /�Ifa/! e H/ti.c/ G ii✓�. � <br /> ��c.� _ �— <br /> — <br /> -- - ---------- -- --------�-- tn <br /> PHG�.ECT AUGt=:c�S(if known) y��� �✓�'�'�'e=5`�^��`� ---— - �y� <br /> Attach four(4)copies of plans for proposed vmrk-U�:;w fo scale and no;e tne icllowing i(apj:fii:�ble. � <br /> •Propertq IJnes •Outline and dimensions of a!I existing and proposed structures on the lot •Existing and proposed utilities <br /> •Centerline o!street •Indicate NoAh •Show any proposed grading changes `Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIOIJS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shali be performed in accordance with this permit and current City of Everett Design&nd <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEP. 1-800-424-5555. � <br /> � r,'En�s,.�i'`'�Gf' ��,,,a,c, .G� �oc�c.tcc�-� cr.� �J�c��" � <br /> OrL �/�Q7� ,' ;-'F _' O <br /> a <br /> _ -e_-:+; 3a4";=;; <br /> I's� i7�i?= <br /> OTtiEF.' 20.CC' <br /> :'"G1pL �CaC� <br /> i��-r7=';` _��l=iiu <br /> P�I 4.f�:� .':��; <br /> ACKNUWLEDGEMENT OF CONDITIONS <br /> / A���— � / The undersigned owner/applicant hereby agrees to hold and save harr.�la�_ <br /> 1 2 � Q 7 the City of Everett irom any and all claims"or d�mages,costs,expenses,or <br /> ��l causes of action that may arise because ot installation and maiNenanue of <br /> Approve t onst cf i D e theimprovementarotherright-of-wayuseheretoappliedforandfurtheraqrees <br /> to remove same upon notice from the Ciry and to repl:ce public properry <br /> damaged thereby \ /� <br /> V <br /> FINAL IN EC Date � � I�'Id <br /> Approved as Consiructed c <br /> Signature of Applic t Cate <br /> WORK AUTHORI2ED�Y THIS PERMIT MUST BE STARTED WITHIN 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT A1.4Y BE CANCELLEO BY THE CITY UPON AfJY STOPPAGE OF WCRK ON THIS PROJECT OV[R 90�AYS DUR4TION. <br />