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7YPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WOFKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA98201 ?.59-8810 <br />C�G.r/N/E /n _ 2G�3 �� <br />Mailing <br />Describe Proposed Work , R/ VE, <br />PROJECT ADDRESS (if known) ��3 M <br />� <br />a <br />0 <br />0 <br />�� <br />%L <br />/ <br />Date 6 /y�c�– <br />Public Works Permit tl 9 7 z9� — <br />Building Fermit # <br />Public Wurks Fee S �` � O O <br />�� - 9YZo3 --'� <br />ZiP Phone <br />7;� Phone <br />kzu3 <br />At�ach four (d) copies of plans for proposed work - Draw to scale and note the (ollowing if appiica6le: <br />•Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centerline ot street 'Indicate North •Show any proposed grading changes •3how measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shali be made 24 hou�s in advance - phone 259-8810. <br />2. AII �v^rk shall be perform�d ir. accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. beSore you di�. TOLL FR'cE NUMBER 1-800-424-5555. <br />/. YX�'��a/�-P C�/LC�-G�•�J� �t�ror �v �� ��rC� <br />� C� C� ��� Zhs�G ��'�'� 6��orc /�a v�-i�S <br />� C��f� r f'ov',�*s 2r� //� - <br />xe;<; <br />� <br />O <br />�/� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT QF CONDITIONS <br />The undersigned owne:/applicant hereby agrees to hold and save hartnless <br />ihe City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action thal may arise because of installation and maintenance of <br />lhe improvement or olher nght-of-way use herelo applied for and lurlher agreEs <br />to remove sarne upon notice from the City and to replace public property <br />damaged thereby. <br />� � .,csc . ,� �4y 9 ,� �`%-� <br />Signature of Applicanl Date <br />OMPLETION.RTIiIS PERMHT MAY BE CANCEU ED BY THE CITYIUPON ANY S�TOPPAGE OF WORK OPI�THIS PROJECT OVER 90 DA S DUIR TIONLY PURSUED TO <br />