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� <br />� <br />Application Fa -'. <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 259-BB10 <br />TYPE OR PRINT ONLY <br />D�MIlt Mo�-s� 3�05 <br />Owner Mailing Address <br />Sar►�� <br />Applicant Mailing Address , <br />Describe Pioposed Work �l.Y1 Ce /�� <br />PROJECTADDRESS (if known) 3 �0 5 <br />Attach four (4) copies of plans for proposed work - Draw to seale and note the following it appiicabte: <br />i <br />Date � "' ` � � l 1 � <br />ww� wo� P�n « 03 <br />Bullding Permit M <br />Public NMrks Fee S_� �� <br />Zip <br />rnone <br />•PropeAy lJnes 'Outllne and dimenstons oi all existing and proposed structures on ihe lot •Ekisting and proposed utilities <br />'Centeriine of street •Indicate North 5how any proposed grading changes 'Show measurements <br />., <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 tnis pertnit 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 1-800-424-5565. <br />�� <br />� IF �i� C.�fy ev�r neeo�s Z`o G�se �fh/:r� �P�yl,f.ot� <br />Zc��/ �iC OW�It�" Si1RLC /�dv� �ie 7'�onc'C a'7� 7�je <br />Cr��'J' �'B��/esf <br />5 Ca..��,cn s�iovL� vie �a�eq wr�� y'e9ara/r y�o <br />�r,,,�e o�'��%s l�ovse's G/Qr'�er .I�er✓iGe„ <br />G �Lace �nCe QS .S/loc.�I� In Q�7`acli¢C� �S'�/7. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unders(gned ownedapplicant hereby agrees to hold and save hartnless <br />the Cfty of Everett hom any and all clalms for damages, costs, ezpenses, a <br />causes ot ection that may arise because of installatbn and maintenence of <br />the improvemant a other rightof-way use herato eppAed for and lurther eprees <br />to remove same upon notka from Me City and to replace publk property <br />damaged thereby. <br />2.- /q- 9 9 �t <br />��%%�%�r ��-w, 2-- r8-9q <br />Signature of Applicant pate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DA1E PERMR IS ISSUED AND THEREAFfER IS TO BE DILIGENRY PURSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CfTY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS WRATION. <br />