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� <br />�� <br />o� <br />PUBLIC WOR^KS PEF�RIiT <br />TYPE OR PRINT ONIY <br />in�A�-��cy�.m�i <br />Owner 1� <br />{\` <br />Applicant <br />Describe Proposed Work � <br />�fe.�t . acrass <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT ,r, i,� <br />3zoo aw� svae� N z <br />Everett. WA 98207 259-8810 � � <br />r, � <br />E' �] O O <br />f�. p ._ i: <br />�.��.\ 3��`t' �� _'' <br />Mailing Address Ci1 <br />�� ���i� i � � <br />L� LJ G <br />��� <br />Mailing Adtlress � � �-a �� Ci1 <br />(.t iY <br />p C Cl �' <br />, <br />���3�,Art <br />Publb Works Pertnit • <br />Bullding Pertntt M <br />i <br />Public Nbrks Fee S � <br />:, ��11-- �I_ s�'1'73 <br />Zlp Ptane <br />�� �� <br />Zip Ptane <br />� ��� <br />,rJ''..MI� <br />�4—� <br />,• L�s�iF q� <br />Attach lour (4) copies of plans for proposed w.�ork - Draw to scale and note the following il applicable: <br />•Property Unes 'Outline and dimensions of all existing anJ proposed structures on the bt •ExisNng and proposed utilkies <br />'Centerline of street •Indicate NoAh 5how any proposed grading changes 5how measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspec:tion shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this pertnit and current City of Everett Deslg� and <br />Construction Standards and Specifications. <br />3. Call �xation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424b556. <br />� � 1�W1.0�12 �i, � � � -?sC+� -� i �� � � j'� p �l-vC.2- LA.1 i � <br />J <br />Co`� -� i GLC Sec,-�-%v� . j7r-��}.e t�.i,tn �' ���"'� <br />�1 <br />�� <br />.�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and seve harmless <br />the Clry ol Everett hom eny and all claVms for damages, costs, expenses, w <br />causes of action that may arise 6ecause ot Instaiietbn end maintenence of <br />the improvement or other righ4ol-wey use hereto applied tor and lurther eprees <br />to rertwve same upon notke from the Ciry and to replace public propeAy �� <br />dameged thereby. �., <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARiED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER IS TO BE DIIJ(iENTLY WRSUED TO <br />COMPLEf10N. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS WRATION. <br />