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�{ PUBLIC VD�RKS PERMIT <br />PUBLIC WORKS DEPAflTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 259-8810 <br />TY�E OR PRINT ONLY <br />�J' �M <br />!� n/�i�L /' /!L <br />��C�� ' ,� <br />, <br />��l� � �'.�v�1<G(.c��� t � L i <br />.._,�,__ ..�____ r:«. <br />rJ1�h/'��unl7n�nl '��a.- J��' �,�U..�sT�'� �,( Tu <br />Describe Proposed Work r�'i✓� . <br />r' ;',( X/�1G � �-/—r�/_� Sc'/, <br />i��9Yrl�T� �J/i�� �A <br />( <� � cGncc•, J� �,%:��t <br />u ��- V,^�G c,i � ���' � <br />�_:(cN�� �/t �/ � � '/c' <br />� <br />oat � ��vvc i..,3c=� a � ��`�Y � <br />Publk Works�ertnit N � y s <br />Building Permk N � <br />��. <br />Publk Works Fee S�Z Z C�� . <br />, <br />�/�c!Jy ��. ��_ y'�'� .Uc:•3� <br />Lp Phone <br />hc� ��'llG� �OG � <br />Zip PhonE <br />f� . <br />C t=A`c'/t/?�Ct /����=%( i <br />_ �. <br />.-- <br />.i.,)n l�i.: .Tie'( �.p. <br />� 7�J �C: ?o <br />PROJECT ADDRESS (if known) `�� ; �� L� �c'�'G� �= �'"� �''J� v L � �'� �`� l � �� ��— <br />Atlach four (4) copies of plans for proposed work - Draw to scale and note the following ii applicable: <br />•Property Lines 'Outline and dimenslons of all ezisting and proposed structures on the lot •Existin9 and proposed utilHies <br />'Cenlerline of street •Indicate North 5how any proposed grading changes 'Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - piione 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br />.� f ...'.e.� �� r� a� �> <<�►�S r��� � �l / - z3 - 9 �3 <br />� <br />a;�L+�wo H <br />ss•s�.;.t ;i_a��� <br />�,s•s�za �rlei <br />Ofi'!�TS9 dSNI/Md <br />ST"T�S �'!i`J!N� <br />.- �� � : -I 00'Q6T 'J3H10 <br />� S�bBG �i <br />1dd!.L:;: 85-SO-� C� <br />0� OS- 1:5� <br />N 9 )�5 <br />OTHER 7� 5.55 <br />-1"OTAL ' � 55 <br />H Ohi430:' <br />�. .�.�SS <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hoid and save harmless <br />the City of Everett irom any and all claims for damages, costs, ezpenses, or <br />causes of action that may ariso because oi installation and maintenence ot <br />the improvement or other right-of-way use hereto applied for and turtheragrees <br />to remove same upon notice from the CN^ and to replace public property <br />damaged thareT�y. <br />� /� i �,: <br />�GZ-E-� , rif � llr/y'rc� z�S/%� <br />Signa ure of Applicant Date <br />WORK AUTHOFlIZED BY THIS PERMIT MUST BE STARTED WITHIN 1A0 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER IS TO 8E DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CIIY UPON ANY STOPPAGE OF WORK ON THIS PR0.IECT OVER 9Q DAYS DURATION. <br />