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� <br />ppplication For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />NPE OR PRINT ONLY <br />:r �l a N t1l CJ <br />Owner <br />tl. �Yli1✓Ltlr% I�-N-/ <br />l yNo y s�,.oi�v1' <br />Address <br />Describe Proposed Work �C� �p' � L <br />PROJECT ADDRESS (if known) <br />�IS � 7 <br />Date <br />Public Works Pertnit H ����� <br />Building Permit N <br />� <br />Public Works Fee $ <br />� c�i <br />City Z�p <br />��. /JL UO 11l /�Ry�J/Gc.0 <br />City Zip <br />P4[/cr✓Cr �Kt—�' <br />rnone <br />���� �s3-zs�z <br />���ecTr w�. <br />9T^c^cP <br />20 <br />Attach tour (4) coples of plans for proposed work - Draw to scale and note ihe following if applicable: <br />•property Lines 'Outline and dimensions of all ezisting and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of slreet •Indicate North •Show any proposed grading changes •Show measuremerts <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 />�� �/� S�Li �% e�SIZ'f� C� !'17YD i h S� d/YrG7 iGy O� <br />�U(/Il .�i %%�� � �? .S��GG�� <br />S� Gv�' SIU� sG�� ll �e f�X�� z H;1 v. <br />7, <br />FINAL INSPECTION Date <br />Approved as Constructed <br />� <br />O <br />V♦ <br />Q <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersiyned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett trom any and all claims tor damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other nght•of-way use hereto applied for and fuAher agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />l/',, �y- 9� <br />Sig ature of Applicant Date <br />COMPLET ON.TIH S PERMHT MAY O[ CANCELLGD DY TIiDE CI7YIUPON DNY SOTOPPAGE OF WORK ON THIS PROJEC O ER 90 DOAYS DUR TIONLY PURSUED TO <br />