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��,� 9 c�a9 / <br />A�•plicationFor � .� /� ��� / <br />� PUBLIC WOF3KS PERMIT Date /� <br />PUBLIC WORKS DEPARTMEPIT Public Works Permit # �� � <br />3200 Cedar Sireet <br />- Everett, WA 98201 259-8810 Building Permit N <br />� 4'OSTING auc o 4 �ss� � �2� � <br />NPE OR PRINT ONLY Public Works Fee 5 <br />S <br />Applicant <br />Describe Proposed Work <br />��J�tV 'C�'��c?L"��� <br />,�.3"s � 2 S' � <br />PROJECT ADDRESS (if known) �JCJf/ LC7W .C-d_. �G�O1YTa� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines •Outline and dimensions of all existing and pmposed structures on ihe bt •Existing and proposed utililiP.. <br />•Centedine of street •Indicate North •Show any proposed gmding r,hanges •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hcurs in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit 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 1-800-424-5555. <br />g �o�� <br />�Lo•�s <br />S. ��E� <br />z`c /� �i�.-^ �.- a�Pro,�co� <br />0'2 ��� 9 -,� s- �6 . (�,�y <br />C17�/ S7�r^e�='�s C�Ca i� a( 4�� <br />�i.GT'4C�C ./ <br />� �yh4�7/96 <br />.� <br />H0009b354 <br />OTFIEF' <br />CHECI; <br />3�56FM <br />5126.00 <br />�1^6.00 <br />�6 33'/ - <br />(� z5i� <br />W <br />� <br />� <br />V♦ <br />� <br />O <br />� <br />L� <br />ACKN0INLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herehy agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because o( instzAation and maintenance of <br />lhe improvement or other right-of-way use hereto applied tor and fudher agrees <br />to remove same upon notice from the City and to replace public property <br />damaged ther�by. � <br />Ql�J � � <br />Signat of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DA1�E PERMIT IS ISSUED AND THEREAFTEfl IS TG BE DIL!GENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON i HIS PROJECT OVEFi 90 DAYS DURFTION. <br />