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� <br />� <br />7YPE OR PRINT ONLY <br />Describe <br />Applkatbn Fa <br />PUBLIC WORKS PERMIT <br />.1� <br />PROJECT ADDRESS (if known; <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, Wq 98201 259-8810 <br />� <br />Date <br />Pudb Works PermH N �B �%% <br />Building PermN M <br />� O� <br />Public Works Fee S _ <br />Phone <br />Q�n�� <br />Atlach four (4) copies of plans for proposed work - Drew to scale and note the followln it "�T'}'- `�U •�''C <br />g applicable: - <br />•Property Lines 'Outline and dimensions of all exist!ng and proposed structures on the lot •Existfng and proposed �il�tiec�4 <br />'Centerline of street •Indicate North 5how any proposed grading changes 'Shaw meysurements 6� <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work ,hall be pertormed in accordance with this pertnit and curcent City of Everett Design and <br />Construc�ion Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-b665, <br />/ • %j%4//1 �tin <br />4S SiiOt.�h <br />Sep4r.G�,'on �ror� ccf,L.fy /nc.ins <br />oh a�a�l¢�,/ ,aL4h . <br />.S /�"'Qi � lo p� o�¢h � <br />7�rs �. LL ,G�., ce a Co•,, <br />qrG 0. , <br />Gcrr o 6S�t�c7�eo uf/ T2 n[B, <br />� <br />hohfh � t.�e.s7� sio/+. o�{' fiY, : C <br />6� e �., ce h�1us'f 6e he�ovCo� <br />Gve�" he¢o�s To U�.'�i$r �'�/�!' <br />R�,,,-,o✓'aL �us� 6e do�,e 4� <br />/� 7`�ie C /�� <br />�"yli�- o� wa,j/ <br />owti�. Ns ex�e ��.e <br />ACKNOWLEDGEMENT OF CONDITtONS <br />The undersigned owner/applicant I�ereby agrees tu hold and save hartniess <br />the City of Everett from any and all cleims for damages, costy, expenses, p <br />causes of actbn tha5 may arise because of installetbn and maintenence of <br />the improvement wother rightof-way use hereto applled }orand {urtl�erepreey <br />to rertave same upon noNce from the Cky and to replace public properly <br />damaged thereby. <br />�� �lac � <br />Signa re of nt Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMR IS ISSU D AND THEREAFfER IS TO BE DIUGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS WRATION. <br />