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:�r <br />TYPE OR PRINT ONLY <br />�C�."^ir3 <br />PUBLIC <br />� <br />�WORIcs DEIMR1MENr <br />C�dr Slrsst <br />A YB201 259-0810 <br />r��g g gi3 <br />� o � <br />s ��� � �� <br />a � as 6 � <br />Data <br />a�ak waw w�mn � 1 7 <br />�„,,�. 53s4D <br />� <br />� <br />Pub4e VVorke Fee t �— <br />'{ S <br />Plar� <br />Describe Proposed Work NEW 4-PLEX - <br />PROJECT ADDRESS (if known) ��/ `' � �a """' - `" � ' <br />Attech four (1) copies oi plans for proposed work - Drew to scele and ^ae the folbwlnq H epplicable: <br />�propeAy I.Inas �Outlina end dimenabns ot all existing end propoeed ntructwes on the bt "F�cisting and proposed utiltties <br />`Centerl!ne o1 streat 'Indiute North 'Show anY p�qrosed O�in9 c�anpea �Slww rt�ea�u�ert�e^U <br />PERMIT CONDITIONS: <br />1. All cails for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be perfortned in accordence with this pemiit and cument City of Everett Design and <br />Construction Standards and Speciflcations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLI FREE NUM9ER 1-800-�124-6666• <br />/ . c <br />- �, � <br />.� . <br />�� <br />��� � <br />� <br />r�% � <br />!/'�f u� �0 <br />�t/�,"`�- <br />u� / � � <br />/n Q S ��i l'` <br />`� / <br />/�� 0 h <br />� <br />he� <br />� <br />O <br />� <br />O <br />a <br />ACKNOWLEDCiEMENT OF CONDRIONS <br />The unders�9� owner/aPWicant hereby a9reaa to MW and aava Iwmleu <br />the City ot Everett from enY and all claims for �ameges, oosls, axpensss, a <br />causes ot acllai lhat may a�ise becauee oi instellation and m�MiNnras of <br />me nnprovemeM or omer �ipht-or-way we hereto eppred ror and n�n� w� <br />to rertave aeme upon notice fiom the City and to rapUa p�lie p�oP�Y <br />damaged tM'eby. _ <br />�(+�; �-�-, - �\S\�"'� <br />Sig ture ot Applk.ant � <br />COMPLETION.R'fHIS PERMIT MA YBE CANCE BLED BAY T�HDE CI V{IUPON ANY ST )PPA6E OF K''ORIC O��d THI PROJE�T OVERR9C� � W�T�"�'Y �� � <br />