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� <br />� <br />TYPE OR PRINT ONLY <br />ppplication For <br />PUBLIC VIIORKS PERMIT <br />PUBLIG WORKS DEPARTMENT <br />9200 Cedar Street <br />Everett, WA 98201 259-BB10 <br />Describe Proposed Work <br />R�>�N 1�i.aac <br />ArED � t'.o�� <br />Maili--•^Addrese <br />..• <br />/�� 2 /9G / <br />Date _,� <br />Public Works Permit N v '3 ` <br />Building Pertnit # — <br />Public Works Fee� �� Ob <br />�g <br />ZiP Phone <br />A 9 �� <br />PROJECT ADDRESS (if known) '' ' <br />g hcable: 1./22i 96 4=09F'M I <br />Attech tour (4) copies of plans for proposed work • Draw to scale and note the followin if app' <br />•propaty Lines �Outline and dimensions ot all ezisting and proposed structures on the I�t •Existing and p%��S�b4i!�4 5 <br />�CentMine of street •Indicete North 5how any proposed grading changes •Show measurements p�, P���i� q,;�5.0� <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 1-8(�0-424-5555. <br />7, Ts�sf�LL P� ��'w••��' <br />j.�qT��O 1G�.3 -9(0 . <br />Approved as Constructed <br />�5'IS-47� <br />Afi..F'ci,�'.O <br />� <br />O <br />Vi <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant here6y agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and mairtenance ^� <br />ihe improvement or other right-of-way use hereto applied for and furiher agrees <br />•,. .e�.,,.,,a �ame unno.,�'+�a fbm the City and to replace public property <br />� <br />COMPLEf10N.R'FiIS P RMIT MA YBE CANCELBLEDTBYTHE CITYIUPON ANY S�TOP AGE OF WORK ON TH S PROJEC OVER 90 DAYS DULRATION.Y�UED TO <br />