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, <br /> Applicatlon For Date ` <br /> � PUBLIC WORKS PERMIT public Works Permit k <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street � � �� <br /> Everett,WA 98201 (425) 257-8810 Building Permit # _ <br /> TO POSTING '�0 ° � 20°° <br /> TYPE OR PRINT ONLY Public Works Fee$ �� <br /> � �v�-� �!� d f�+iu.� A►� 9820� zsa - 3 �Zs <br /> Owner Mailing Addrass City Zip Phone <br /> Applicant Malling Address City Zip Phone <br /> Describe Proposed Work ����� �� � <br /> � <br /> � <br /> � <br /> PROJECT ADDRESS (if known) �%1 �eh�✓OGV G � <br /> Atlach four(4)copies plans for proposed work•Drew to scalo and note Me tollowing il applkabie: O <br /> •Properry Lines •Outline and dime�sions ot all existing and proposed structures on Me bt •Existing arW proposed ulilitles � <br /> •CenteAine of street •Indicate North •Show any proposed greding changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE Z <br /> PERMIT CONQITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be performed in accordance with ihis permit and current City of Everetl Design and � <br /> Consiruction Standards and Specitications. . <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. ♦A <br /> ♦// <br /> � In s��/ 5il-� -Ferlcc r S-� l�� �ZoS � :-� ,_ ,�}.., O <br /> � � z,��� �5. a <br /> ,�;r c �.:. <br /> ���. _ ta o; <br /> _Q�. . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �r".y,/1 The undersigned ownerlapplicant herehy agrees to hold end seve harmiess <br /> j// 3 3� the Ciy ot Everetl irom any and ell claims for demages,oosts,expenses,or <br /> pr ve or ruc�on a e causes ol actlon thet may er(se because of instelletlon end meintenance of the <br /> improvement or other right-of-way use hereto applied For end NAher agrees to <br /> i%��-- �.�� �, remove same upon notica trom the City and to replace public properry dam- <br /> li-Y� !`' a ed there , r <br /> FINAL INSPECTION Date n�,,� q/�q <br /> Approved as Constructed � �R� l_.(NL•�� ["l I <br /> gn re o ppTicaT a <br /> WOfaK AUTFIORIZED BY iHIS PEHMR MUST BE STARTED WfhilN 7B0 DAYS OF DATE PERMfT IS ISSUFO AND T}EREAFlEA IS TO BE DIUC#MLY PURSUED TO <br /> ..........-...... ...�...,.-.............'.......'.��..e..t.,�n�.�..�err�.w emm�n_c K u.vr rw n.nc mri�enr nvro w nevc n�e�xiu <br />