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� °����Fa� � q � <br /> PUBLIC WORKS PERMIT °�e �� <br /> � PUBLIC WORKS DEPARTMENT Public Works Perr.ilt M <br /> 3200 Cedar Street <br /> EvereB,WA 98201 259-8810 Buiiding PertnN M <br /> i <br /> TYPE OR PRIN7 ONLY Publfc Works Fee S � <br /> �'�urn � �� � I�il �� `�( �cc.) <br /> Owner T Mailing Address CMy Zip ?hone <br /> Applicant Malling Address Ciry Zip Phone <br /> Describe Proposed Work�i�' i! c'i <br /> ��,rk�n _ l� �' a r-a � <br /> � <br /> PROJECT R.f7DRESS(if known) �c.3 � �1/P�(L1 C.l� � <br /> - J �Attach f�ur(4)copies of plans{or proposed work-Ciaw tc scale antl note the following if applicable: O <br /> 'roperty Lines �Outline and dimenslons of all existing arid pmposed structures on the lot •Exlsting and proposed utilkles <br /> 'Centertine of straet •Indicete North 5how any proposed grading changes 'Show measuraments � <br /> � DO NOT�NRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calis for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. All worlc shall be performed in accordance with this permit and cuRent City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground 5ervice 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> :, <br /> Q• �i2vi� Pvnsion Covr�rol �s d;�� � �(uL 12t��ks � <br /> � ��1S�:r n �. �� I -�.��el� • a <br /> ,S, (�e�.� G�-l� S�}re�-ES GLe� <br /> Co . �Ow�N�,/'�ia� L.vS�r�e-,r �'z'ir�c�y�, y5 f�g�C� '�o �2 <br /> �JAi1G�-• (1 <br /> 06-09-9T 10:32AM <br /> M 97168 � <br /> ACKNO EMENT��1DfT10NS ' <br /> � '�j/�� /_ � The undersi ncti owned hereb to hold end save hartnless <br /> 9 Yyp <br /> /'�' �O Uie City of Everak from an, I claim9`ftlr�a at expens�$ w <br /> Approvetl for str�ction Date causes of actlon that may ar(se because of Installat��tenaMbb� <br /> che Improvement a ott�er rigM-of-way(�s�pr�plled for and further agrees <br /> s <br /> �/ � to remove same upon notice hom the Ctty and to replece publlc property <br /> �' 7 f-r' darnaged there��by� — <br /> Fl �AL INSPECTION Date �i j� <br /> Appmved as Constructed � <br /> '�( �// lQ-�D'`/7 <br /> /\ <br /> ` S gnat re of Applicant pere <br /> WORK AUTHORIZED BV THIS PERMR MUST BE STARTED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER IS TO BE DIIJGENTLY PURSUED TO <br /> COMPLEf10�.THIS PERMR MAY BE CANCELLED BY THE CITY UPON ANY STOPpqGc Of WORK ON THIS PRQIECT OVER 90 DAYS WRqTION. <br />