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� <br />�� <br />TYPE OR PRINT ONLY <br />PUBLIC WPO�RKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Street <br />Fverett, Wq ggpp� pgg.8810 <br />�� �vdn�r 1�24 bt�� <br />ow��a� <br />Mailing Address <br />Describe Proposed Work <br />r� <br />Date ��� � <br />Public 4yarks Perm% q % / / / � <br />—+—f�/ �tiL_— <br />Building permit 8 <br />Public Works Fee $ ZS � <br />Z� - lRf� � 131� <br />Phor�e <br />PROJECT ADDRESS (if known) <br />%O,L,ji �'%% � i 1 / � i <br />Attach four (4) copies of plans for proposed work - Draw to sca�e and note the follo�vin d a licable: , <br />� <br />�P�Perty Lines 'putline and dlmensions of all ezistin antl 9 PP <br />'Centerlive of street • 9 Proposed siructures on the lot •5cistin and <br />Indicate North 5how any proposed gretling chan es • 9 Proposed utilities <br />9 Show measurements <br />PERMIT CONDITIONS: �O NOT WRITE BELOW THIS LINE <br />1• All calls for inspection shall be made 24 hours in advance - phone 259•gg�p, <br />2• All work sh�ll be performed in accordance with this perrnit and curren: City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMB <br />�� <br />S <br />ER 1-8pp-424-5555. <br />Y%1Z � niz � h S, ( � -�r.nco G� $uF� �� <br />� ��P o � s lo�e <br />Ceh71'�I G��'v�Gfid �! O� <br />�R7v �G Zr�7 �� C ✓�si G v� <br />rV��Z Wor (GS <br />1n sPe c-f�v <br />1'�w 000axi <br />s�s.o� <br />szs. o0 <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersipnetl owneNapplicant heraby agrees to hold and save harmless <br />the City of Everett Irom any and all claims tor tlameges, costs, expenses, or <br />causes of action Ihat may arise because ot installation and maintenance of <br />ihe imprpvement or other right-o(-way use hereto applied (o� and lurther agreos <br />to remove sarne upon notice from th: City and to replace public proper}y <br />tlamaged thereby. <br />\ , <br />---• •�� �•��..�eeu efr IHIS PERMIT MUST BE STARTED WIT}iIN 180 DqYS OF DqTE PERMIT S It UE1D AND THEREq <br />COMPLE710N. THIS PERMIi MAY BE CANCELLED BY THE CIN UPON ANY STOPPqGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. Date <br />FTER IS TO BE DILIGENTIY PURSUED TO <br />