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� <br /> PUBLIC WORKS PERMIT �-�_S—`'1(� <br /> Date <br /> PUBLIC WOR�EPARTMENT /� � <br /> 3200 C Street Public Works Permit N ��(// /�O <br /> Everett,WAgg 259-BB70 ��� <br /> Building Permit N <br /> TVPE OR PRINT ONLY � S S �--- <br /> fe? Q Public Works Fee y� <br /> J�11-L S1-Vlt�ra- I ►�1v :x :x <br /> a�,a, � - Ma����a�SM�.�' Po �o�t, S4�', <br /> � City Zip --� <br /> W , � Phone � <br /> Applir.ant Malling qtldress ��'w�'�L <br /> ���Y Z�P Phone <br /> Describe Proposed Work �Qy&=_ <br /> - = �S � I.yA�LI C /' � � S� C(„ N � <br /> /� � <br /> PROJECT ADDRESS(if known) y� I�,��J�T' n� u�, � � � <br /> Attach lour(4)copies ol plans for proposed Work-Draw to scale end note tha lollowing II epplicable: � <br /> �Proparty IJnes �putline end dimenslons of all exisling and proposed structures on the lot •E�Isting and proposed utllities <br /> •Centerline ol straet �Intlicate North •Show eny proposed g�ading changas •Show measurernents O <br /> DO NOT IYRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: <br /> 1.All calls for Inspection shall be made 24 hours in advance-phone 259•881 D. Z <br /> 2.All work shall be periormed in accordance with this permit and current City of Everett Des(gn and <br /> Construction Standards and Specifications. O <br /> 3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBEq �_gpp_42q.555� <br /> � � K�� � �-�y s�r��ts �I��, � «�� �;��s. I— <br /> 5� P�bv�de e- rnson �o�� �-,� I as d;✓Gr,tC'ob ►�y �,bl�cvorlc�, � <br /> �N5�c4nr. a <br /> . C The undersigned ownerOpplcDGEh E b�09 eOSNolhodNend save harmless <br /> j the Clty ol Everetl(rom any and ell claims for damages,costs,eKpenses,or <br /> Approvetl or Cqry�Nctlon// pe� causes of action ihat may arise bacause of installatlon end malnlanance o1 <br /> ,� the Improvement or other nght-ol-way use hereto npplied lor and funhar egiees <br /> /� � " � %'/�j� demaged t Se yYU� notice from the Clty and to replace puhlic property <br /> f�Nn��NSPECTION —��_ � <br /> Approvetl as Constnicfetl Date � <br /> Signature ol Applicant 1/ �'��^��� <br /> WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN iB0 DAYS OF DATE PEqM1T IS ISSU[D AN�THEREAFTER i5 TO BE DILIGENTIV pUR;�U 061 O <br /> COMPLEf10N.THIS PERMI7 MAV BE CANCELLED BY T11E CITY UPON ANV STOPPAGE Of WORK ON THIS PROJECT OVER 9ll DAYS�UqAT10N. <br />