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� <br />� <br />TYPE OR PRINT ONLY <br />Owner <br />� R�� <br />— Ap�icnn� <br />Describe Proposed Work <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />PUbLIC WORKS DEPARTMENT <br />3200 Cedar Slreel <br />Everett, WA 98201 (425) 257•8810 <br />� L.c. <br />� <br />Alailing <br />��—� G l. �-c. �-C.. �� � � 0_� <br />ary <br />Date ���Q � � <br />Public Works Pertnit M <br />Building Permit # <br />Pubiic Worka Fee S � - <br />Lq�— <br />' w h 9 8� : _ <br />z�P � <br />Ciry Z�D ' <br />� lk-�� G �� 2� 1: <br />��t � � <br />Q \ \a�,S <br />PAOJECT ADURESS (if known) � ��,'�-' � S ��U <br />Attach lour (4) copies p�ans lur proposed work • Draw to scalo end noto Ihe Idtowing il applicablo: <br />• Property Lines • Oullinc and dimansions ol all existing nnd proposed slructures on Ihe bt • Ealsting end proposed utitioes <br />. rnn�nr�inc ol streot • Indicata NoM • Show any proposad gradir�7 changes • Shrnv moasurements <br />DO NOT WRITE BELOW T' �IS LINE <br />PERMIT CONDITIONS: <br />1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be peAormed in accordance with this permit and cunent City ol Everett Design and <br />Construction Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-124-5555. <br />�. Mt�c hG� ti� of rGt�,� h ihy �a! I �� r�� or�r�d 5��e <br />�r�� �►�.k 5►�ll ho�" excecd 3� . <br />� <br />K� �,��ti <br />, <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The urrlersigned ownerlappNrant hereby ayrees to hold antl save �armless <br />tho Ciry d Everen Iran any and all daims for demeges, msb, expenses, a <br />causes ol ecCon tAat may arise because d MMaNeEon ard mrnb�r�e o� Me <br />knprovement a olher righl�ol•way usa herelo eppikd br and huM�er a9rees b <br />rertave same Wo^ notice ham Me Ciy and b �aWace P�K P�WBM �^- <br />aged thereby. <br />gne re Men <br />�� <br />WOfiK AUTFIOFi�D BY iH5 PEFiIuYi MUST BE STARTED WfTHIN 180 DAYS OF DATE PEfiM IS ISSUED AND T}EREAFIER 1570 � OlK'aBd1LY PURSU�10 <br />CDMpLET10N. THIS PERAAIT MAY BE CANCE1Lm BY T}f CffY UPON ANY STOPPMCf OF WOFr( ON THS PRQECT ONER 90 DAYS OUFiAT%ML <br />