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�: <br />TYPE OR PRINT ONLY <br />ppplitalion For <br />PUBLIC WORKS F'�RMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireel <br />Everelt, WA 98201 (425) 257-8810 <br />; � °OSTING °EC— <br />JULIE AL 1821 19TH DR MUKILTEO 425-290-1456 <br />Owner <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />MailingAddrass City <br />NFW N011SE — BASIC 2040 <br />Date 8/5/99 _7 <br />Public 1Ncrks Pertnil # ��1,s <br />Building Permil N C9908-005 <br />Public Works Fee $ Z� � <br />Zip Phone <br />n rvna <br />Anach lour �4) coplos plens for proposod work • Draw to scale aM nuto tho tollowing if epplicablo: <br />• Propony Lines • Outline and dimonslons of ell nxisting and proposed struclures on Mu lol • Existing and proposod utilitlas <br />_,.__._........� ��.ee� . Irdiraln NoNI • Show any proposed grading chan9as • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />7. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Design 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 />�", T�iru;v Y��� � � -�o ��►' ��5��s� ���'s • o►' <br />z) �-r, �� �I�o►� -�''�' Pe,�' crb-j s�n��ds , <br />5. 5 � dG� �S �' <br />�; .� s-;eR� <br />s �d #�(, �oZ, Go4: <br />�'cc <br />GJU. <br />1�' <br />7C <br />. +^9f <br />� <br />� <br />� <br />V / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undorsigned oe�nedapplicaM hereby ugrees lo hold and savo barmless <br />ihe Ciry of Evaretl tran any and ell clalms lor damages, cosLs, eMpenses, or <br />causes ol acuon th�l may anse berause ol Installation end melntenenca ol ;ha <br />improvement or olhar right•ol•way use hereto applied for flnd h�Mer egrees �o <br />remove same upo tice irom the City end to replace public property dam- <br />aged N y. \ <br />�`f�� ,D��, � �� �� <br />CDMKPLEiION.TH�PEFiMRMAYBE�CANCELLE BY�TNE�CfTYUPONlWYST�JPPAGE OF�VJOFIKIXJ�THI9NPF;QIECTOVER90DA WRAl10N.YPURSUFD70 <br />