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Datc$� <br />qpplication For <br />PUBLIC WORKS <br />Print or Type Onty <br />�oo <br />70 <br />M�ilin7 <br />Describe Proposed Work <br />Project Address lif knowN <br />/ <br />.••. I Pub��c \YOrhs Pl�mil • 9S 39� <br />Blag DeD�. • <br />ri <br />r.� <br />PERMIT;� <br />O <br />i: <br />nj <br />:f <br />I'J C` <br />fJ (, <br />:< �! <br />� <br />�i r:i <br />". i�i <br />t. <br />!"� (i <br />P�ei�c wo�ks vee 5 <br />io�ai fee <br />LPSS AOOL �G! �d�0 `S � O��— <br />Batanw Ouc <br />S �— <br />G�2 -32 Z 4p/38 3 / <br />Allach lou� (d) copies o� Plans to� qroposed wo�k � Drav.� to sr,ale an:f ����� C°����line o1 S�r�e��cab�e: <br />• Propeny Lines � Indicale Norih <br />• Outline and dimensions ol all existing and � chow any r.roposeA gratling changes <br />proposetl slructure5 on the lot � Show measuremenls <br />� Existing and proposed utillties <br />i <br />�� �-�,�c� <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. AI� work shall be pedormed in accordance with this permlt and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Gall Location Underground Service 48 hrs. betore you d.q. TOLL FREE NUMBER 1•500-424•555 . <br />" �� / �/ �.%�a- C.��n. a.t a G�� �`'"'-e-1L <br />Approved as Gonstrur,�ea <br />�PUBLIC WORKS DEPARTMENT <br />� 3200 CedarStreet <br />Everefl, WA 98z�� <br />Phone:259-8870 <br />—J'�Z < � <br />� <br />� <br />i <br />t <br />[ <br />ACKNOWLEDG[A7ENT Of CONDITIONS <br />The undersianed ownerlaUP������ hereUy agrees to hold and sacr <br />less Ih�• C�ly of Everetl Irom any and all claims lor damages <br />expenses. or causes ot ac�ion ihat may arise because ol ins�: <br />and inaiNenance ot Ipe improvement or other right�of�way use <br />3pnlied tor and furiher agrees lo remove same upon nolice b <br />C,!y and to replace Public property dama ed thereby. <br />�� G <br />5 � atur �I Applicant <br />1NORK AUTHORIZED BY THIS PERMIT MUST BE STARTED � <br />gEopIDLAGCNOTI DPURSUED TOfCOMPLEDION.DTH SEPEAMIT` <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK C <br />FROJECT OVER 90 DAVS DURATION. <br />