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TYPE OR PRINT ONLY <br />Owner <br />Describe Proposed Work <br />Applketqn Fa <br />PUBLIC WORKS PERMIT <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evereq, WA 98201 (425) 257-8810 <br />1�ai8ng Address Gry <br />/L( O ' <br />. _ �. � <br />oace <br />8�13/9R � <br />Public Works Pertnit M <br />Building Pertnit N <br />Public Works Fee S �^ <br />Atmcn tour (e) coqes �tans ror provosed w«k • oraw ro scale ara rwte n,e �a�owirp u aap�irao�e: <br />• Property Urres • Outline and dimenslons of all edsting a�d proposed stnKtures on the bt • Existlng and proposed utili8es <br />• Centerline d street • IMicate Nath • Staw any Droposed 9radi�9 �hanges • Shav meawramenta <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be peAortned in accordance with this pertnit and cunent City of Everelt 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 />�' �r��� � � 'j)��n '� 307 — i�r-rx t�id�'h-20' <br />��y= <br />_ ��. <br />�G.,, <br />_ ;:� <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLED6EMENT OF CONDITIONS <br />The urWeroip�ed ovrt�edepplfcent hereby a{Kees ro Aold ard ave hemiesa <br />tlx Ciy af Everett hom any and aN clalms for den�epu. wab, a�enass� a <br />causes a ecum me� m.r adse eecawe a �npol.nm .nd msY,ee�w,ce a m. <br />�mpwemen� «onar rqma-way uae nerero epplisd ar ana n,mrr apees a <br />remow �emB u�wn rwtice hdn thB Gly and b replece D�� D�PBKY �. <br />aped thereby. <br />���� � <br />�e� — <br />wowcnur►aR�o evn+�s �ta�+rr�nusr ee sru�o wrt►+N �eo w,vsoF a+� aea�rs ssuEn�ron�� sm ee o�x�e�mr�m <br />a�rtaa.�saean.+rrtiaveec,�r�ceteoevnfarruPar�wvsTo�naE oFwowcoriTMs�o�crove+wo�rsax�noK <br />