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/�pplicetlon Fa <br />� PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett. WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY <br />pescribe Proposed Work <br />\ <br />Date LJ_/ %�� <br />Public Works Fertnit N <br />a��b�� Pa�,�� « RG�i �S -024 <br />TJ POSTING ����A� PublicWorksFeeS N C <br />Meilinp Addrese <br />PROJECT ADDRESS (if known) � ' <br />City 7�P <br />Ciry z1P <br />.1�; nr► <br />Pno�e <br />Attach tour (4) copies plans for proposed woAc • Draw to scele arW ��sed stnutures on pre bbleExisting arW proposed utili6es <br />• properry lJnes • Outline end dimensions of all e�isH�p and propo <br />. ee..mdim nf aheel • IrWicete North • Sfaw anY Proposed 9reding changes • Show measurements <br />p0 NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls tor inspection shall be made 24 hours iii advance - phone (425) 257-8810 <br />2. All work shall be peAormed in accordance with this permit and curcent City oi Everetl Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 46 hrs. betore you dig. TOLL FREE NUMBER 1-800-�2+-5555. <br />�, (�;� Y'u.ord5 i���cz+te -�a�. v►GuJ (�'�o r�� �:�9� �.c��ll <br />�(�,d o�,�r exi � n� s� d� ,se��v'• <br />��Plz�.n� a9r�res � c��ker •. <br />1� rt Ioca�EG s;dest� <br />( �wt,r 1� ( �. Ptir►n:-� <br />o�' 2� �p rud� s�� s�e�P.,/' <br />f .�M dn CIGv ��%� Ovl <br />v�t�lr�ad) <br />�p w,cvfs V PG w►+a�e <br />� v n D6�r 7rG�%f �i on � P IvM �o; n9 <br />� •' / <br />��rin�t +'�v; red, <br />ACI(NOWIEDOEMENT OF CONDITIONS <br />The underslW�ed owner/ePPNcanl hereby eprces to hold and �ave hamisas <br />the City of Everett Iran enY ard dl cleNns tor dema9es. oosts, e�enees, a <br />causes o1 ac6on Met maY erise be�ause of insteMation end meinMrence d tl�s <br />knprwoment a dher rlgMd•wey use Mreb ePWled for and NMer eqrees lo <br />remove same upon na1k0 han the Gry erd ro replace publb piap�rry dem- <br />e�° �� 0.,�.� qlIl4 q <br />�gna <br />WOfiK AUII�OR�D BY THIS PERAAT MUST BE STARTID WRMIN 1B0 DAYS OF DATE PEFidfT IS 6Sl�D MA1lEFE�FIER IS TO BE OLIOENILY PURSU�iO <br />CONpLEi1pN.1HIS PERMR MAY BE CANCEILE� BY l}E CfTY UPON ANY STt7FPA0E OF �MOFi( ON 1HS PRO�ECTOVER 90 DAYS DUlMl10N. <br />