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TYPE OR PRINT ONLY <br />pcvC G�/—� <br />Owner <br />i <br />pr rk Sv c�,� <br />Applicant <br />Describe Proposed Work <br />Appllcation For <br />PUBLIC WORK� PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 259-Q�tq 2 4 �� <br />TO POSTINfi_`� �� -- <br />��� � <br />Mailing Address <br />�D� /5�'yu <br />PROJECT ADDRESS (if known) <br />Mailing Address <br />y p x <br />Date � �/ /� / <br />Public Works Permit N / 3�� <br />Building Permit q <br />Public Works Fee $ f.� O O <br />� �(/��� �e�3 —�S-GL <br />�� <br />,` <br />Gily <br />�ip <br />F'hone � 6 � <br />/i1 R yur�f _ 6S- j— Z.S� �, <br />C��'7�� � <br />Atlach four {4) copies of plans for proposed work - Draw to scale and no% ihe tollowing if applicable: <br />•Property Lines o0utline and dimensions of all existing and p�oposed siructures on the lot •Existing and proposed utilities <br />•Centerline of street •Indicale North •Show any proposed grading changes •Show measuremeNs <br />DO NOT WRITE BELOW ?HIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 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 1-800-424-5555. <br />7,� C'Orlhec�/Dh TG [�Q7�G.� �S/h <br />w:f� P,�c. ,��� . <br />S d/�L'/J � rc� �r7 CiL �Lh !�4G/h <br />/� �/ / <br />�ih GXiS�i'yr� %fv)oG.C-OCJ7— <br />�. CaIL i„s?�c�or fo �%sc �.ss <br />GUO/^ �. <br />�i�sf 6e 1-•za �e <br />��sf bo f�ro�� <br />Or o�/^rLLco� <br />6e� i n ., i,,.�y <br />COMPLEf10N. THIS PERMI f MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAY:; DURATION. ��6�� <br />_ --��-----�_ . <br />