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� <br />TYPE OR PRINT ONLY <br />Describe Proposed Work <br />Apptication For <br />�UBLIC WORKS PERMIT <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-BB10 <br />Date � <br />Public Wnrks Permit p _ � �� <br />Building Permit q <br />1�..'��l9C✓%tA'i�e'� L�1��+�19^�.`i ::C':P <br />Pub'Ic Works Fea $ , uf <br />�g Z�/ �/'' L -,,,� nooD��ocs <br />M� �2- 4J L.�co►'v �� �5. y;; L',R 3 �� 3—''71 <br />dlingAddress City 2ip C�iECf; Phor16�C.C1p <br />�1 <br />ap <br />Attach four (4) coples ol plans for proposed work • Draw to scele and note the Iollowing II applicable: <br />•Property Lines 'Outline and dimensions of ell existing and proposed struetures on the lot •Existing and proposed utllities <br />•Certerline ol ctreet •Intlicata North •Show any proposed greding changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 nours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with tliis permit and cunent City of Everett Oesfgn and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�� �ilau� da��r ,bl��/���r�a a nd ./ vy� �h �7 <br />— ✓1 %D ��,Ur,tY_, o� �r� /f?ov�Y�g . <br />_ <br />.�� i�s�.�,� e,�s,� �r�� � �,��;� a� � <br />�ibl,G w�l-�s <br />_��. __. _. <br />���- ( =n <br />i <br />,-� S�-�. <br />nnnurvartciwrv �ale � <br />Appioved as Cansiructed <br />�-15�� <br />ACKNOWLECGEMENT OF CONDITIONS <br />The undersigned owner/apphcant hereby ngrees to hald and save harmless <br />the City ol Everett (rom eny and all clalms for damages, costs, erpenses, or <br />causes o1 action that may arise because of Installatlon and maintenance ol <br />the improvement o� other dght-of-way use hereto applied lor and lurther agreos <br />to iemove same upon notice Irom tha City antl to �eplace public propetly <br />damaged t�by. <br />' ��i) <br />Signature ol Applicant Date <br />WORK AUTFiORIZED BY THIS PERMIT MUST BE STARTED W'ITHIN 180 DAYS OF DATE PERMIT IS ISSUF.D AND THEREAFfER IS TO BE DILIGE4RV PURSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANV STOPPAGE �F NIORK ON THIS PI70JECT OVER 90 DAVS DURATION. <br />