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qpplication For ��� 7 � <br /> �i,;✓� PUBLIC WORKS PERMIT °�'e-= <br /> ���Tr pUBLIC WORKS DEPARTMENT Public Works Pertnil N ���— <br /> 3200 Cedar Stree� ''' <br /> Everett,WA 98201 259•8810 �� Building Permit q — <br /> � � <br /> r.> r.', �7 ,Gl� <br /> r� ff. <br /> !', ,;P4b�ic Works Fee S ��� <br /> TYPE OR PRINT ONLY � . r; r : <br /> �r� I�sr13�,uK ����ec��; �y ����r <br /> Owner <br /> Mailing Address City r � . ��P <br /> /� ��,/+�y� (� / c ;y�� A �;—�� ' �,3 � g5y-cY� y� <br /> C_c.V�.�—Iti--J�J�/��Ll.� /��� �`J�� ' r"1V '� ��1�/� "� Zi Phone � <br /> Applicant � Maihng Address City P <br /> ( � <br /> Describe Proposed Work E V� � E��L LF W <br /> �EL77�S/U �r�' �-IT� S lDEcc��S'<.k � <br /> � <br /> PROJECT ADDRESS(if known) !1 S� EvC�G��� f�� m <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note Ihe following if applicable: O <br /> •Property Lines •Outline and dimensions of all ezisting and proposed siructures on Ihe lot •F�isting and proposed utilities <br /> •CeNedine M street •Indiwte NoAh •Show any proposed grading changes •Show measurements � <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 ihis permit and current City �f Everett Design and <br /> Construction Standards and Specitications. � <br /> 3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-500-424-5555. <br /> 9. �ema� srd���<c -Eo � ��� � e.�,�s�, � <br /> J � � f . ,,�,� �f �- �r� ���� O <br /> ��a! ���n #"3or'e C� �/ ,h s�ar� 33�-�g� 0. <br /> . �_. <br /> �►^f��^ � �ohu�c � (a�e �¢.�-, <br /> AC'<NOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby 2yrees to hold and save harmless <br /> ��� Ihe City of Everett fmm any and all claims lor damages,cosls,expenses,or <br /> causes ot action lhat may arisa bewuse m installalion and maintenancc ol <br /> qppove onst c�i n ��e theimprovementorotherrighbot-wayuseheretoappliedforandfuAheragrees <br /> �I �� / to remove same upon notice Irom the City and m replace public property <br /> •� //-�€'L�� //�� � _�-C'/ ,. dama9edthereby. <br /> /// l <br /> FW� CTfON �1e <br /> Approved as Constructed <br /> Signature ot Applica•d Date <br /> COMPLETIOORIHED ERMIT APAYRBE CANCELBI ED BYTH�E CITYIUPON ANY SOTOPPAGE OF WORK ON THIS PROJEC 0 EER�JO DA�YS UILRATIONLY PURSUED TO <br />