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PUBLIC WOnRKS PERMIT -Y il� �9 � / <br /> � Date_ — <br /> PUBLIC WORKS DEPARTMENT Publlc Works Permit M __/�ei��SS <br /> 3200 Cedar Slrcet <br /> Everett,Wq g8201 259-B810 <br /> Buildiig Permit� <br /> TYPE OR PRINT ONLY Public Works Fee S ��n� <br /> �ff"� �n�"�n/G_ C�6. P.n./�.jX 37� �� O/�1,� s.�cf' W.9 /Z- <br /> Owner Malling A dress Ciry ,Clp Phone ��'�� <br /> v_�� '"S. <br /> Appllcant Moiling Address Clt <br /> Y Z�P Phone <br /> Describe Pmposed Work e L�q2 S r TE 'Fa,� 2e�iu> i �rv�r� �,p,,,, �� <br /> c�sNr�2 . W <br /> H <br /> � <br /> PROJECT ADDRESS(if known) �Q� �t1� (�4-s/.v p �� � <br /> „�fttach four(4)coples ol plana lor p,opoyed work-Drew to acale end note Ihe following H appllceble: m <br /> 'Proparty Linee 'Outline and dimenslons of all ezlsting and pioposetl structures on the h�t •Exlsting end proposad utilltles O <br /> _. . �Centerline o}et�eet •Indicate North •Show eny proposed prading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINF � <br /> PERMIT CONDITIONS: � <br /> 1.All calls for Inspectlon shall be made 24 hours in advance-phone 259-8810. <br /> 2. All work shall be performed In accordance with this permlt end current City of Everett Design and O <br /> Constructlon Standards end Speclficatlons. <br /> 3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-800-424-6666. <br /> 7. �UhF Z�O /.� QOhe /�p�, Q v, <br /> �'^ �M/2'Cf O <br /> ,oL4h o���o� 9��9,� �'� �-��� <br /> 5' f��., ¢0 6�. ,�`39�� � s, , _ a <br /> • �hsfal�c✓ .de.�o'�z CLear.��� �e�cf ��jO . <br /> �. f�w y`.-�.�s -to �y, �� g6 <br /> SIaLC ro.c:E�e �.r-f.,arf a { �i:r �`?je� AQR ��`9 .�- <br /> 4o��ed �rpf�C�G�,h � 59i�y ��"' .. ....SV .of �ovg�on �. <br /> ��eU����n9 <br /> ACKNOWLED(3EMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby egrees to hold end save harmless <br /> � J �f �q y� Ihe Clty ol Everett Irom any antl ell clelms foi demagos,cosfs,ekpenses,or <br /> ved� nst I p �a causes af ection thet may arise baceusa ol Installetlon and meintenanca of <br /> �� thelmprovementorotherdgh6ol-weyuseheretoappliedforandfurtheragrees <br /> to remave same upon notica from the City end to replace public property <br /> � � Q� damaged thereby. <br /> �F I' Date ^ � <br /> Aoproved ae ConsVucted � _ / /L,,,J_, <br /> �'^�M �'ii%is�1"`.I <br /> Signah�re ol Appllce Date <br /> WORK AUT1ibRIIED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAV BE CANCELLED BV THE C11Y UPON ANY STOPPAGE OF WORK ON THIS PpOJECT OVER BO DAYS DUR,4TION. <br />