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� �PIiCEtwn Fa <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everefl, WA 98201 259-BB10 <br />TYPE OR PRINT ONLY <br />npp�lcant <br />a I W. 6e.es � F <br />��tY <br />.,, <br />o�y ; � <br />i� �. <br />Describe Proposed Work �_e.- c\ 0 1] f� V P <br />W e. 11 a'"I' e d�e aF' D r; .r e w <br />Uate `� � � 9� i l 98 � <br />Public Works Permit M ��%� <br />.quiltling Perml� N __._ _ <br />Public N/orks Fee S � � ____ <br />Phone <br />PROJECT ADDRESS (if known) 1l l V,1, �� e e�� S �� � V e C N. j �T�,tJ r� <br />Anach tour (4) copies ol plans for proposed work - 9.sw to ncale and note the following il applicable: <br />•Property Lines �Outline and dimenslons ol a�l existing end pmposed structures on Ihe lot •Existing end proposed utllitles <br />'Centerline ol street •Indicate North �Show eny proposed grading chsnges 5how measurements <br />�as 35'3- <br />PERMIT CONDITIONS: <br />1. All calls for Inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with th(s permit and current City of Everett Design end <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FR�E NUMBER 5-800-424-65; <br />, = <br />�,'�i;�,�,,�.wt// < 3' bt I I <br />- �R,�� �r <br />lra; <br />�,� <br />'� a <br />� <br />.� <br />� � <br />' ' ir <br />D te <br />�� j(!' aC <br />� <br />�� <br />� � � <br />� ' , <br />ACKNOWLED(3EMENTOFCONDITIO ! <br />The undersigned ownedappllcant heraby ag/aes lo hold nd mve harmleae <br />the C8y of Everetl lrom eny and ell claime lor dameges, ste, eMpensea, a <br />causes o! actlon that may arix beceuae ol Instelletbn a d malntenance o} <br />tM improvement w othar righ4ol-wey use herato eppibd fw and luhl�er ap�ees <br />to ramove seme upon notica l�wn Ihe Clty and to replace public property <br />damagetl thereby. <br />IOpProved es Constructed I / ,� ��A ��,,,�� 6l/9l ��' <br />Sig ture ol Appllcant Date <br />WOfiK AUTNORIZED BV THIS PERMft MUST BE STARTED WITHIN 180 DAVS Of DATE PERMR Iti ISSUED AN� THEREAFZER IS TO BE DIl1GENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY f E CANCELLED BV THE CIT/ UPON ANY STOPPAOE OF WOF IK ON THIS PqOJECT OVER BO DAVS W FUTION. <br />