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TYPE OR PRINT ONLY <br />Owner <br />qpplicalion For <br />NORKS PERMIT <br />WORKS DEPARTIdENT <br />�200 Cedar Street <br />Wq g8201 259•8810 <br />a � � ���'sT. � <br />Mailing Address City <br />�.� .� in Trf �- � <br />�escribe Proposed Work _ � � �ti^ "'�` <br />'% .T � <br />� � -;C� 1;•.,'l✓��Ja� ' ;� � <br />T � _ �-. <br />�,� ^�r .�\L � — <br />Date � (-i I � /I� � � <br />Public Works Permit R I"� �✓ I <br />Building Permi! tl <br />Public Works Fce $ � <br />�,�o l 33% <br />Z�P Phone <br />-i `7°�U I J3�- <br />G .l --^ 1 <br />.�. �t.• <br />.- •�� „� <br />PROJECT ADDRESS (if known) �.�` � J — <br />U � if applicahle: <br />Attach lour (4) copies of plans for proposer n <br />�� �res on the lol 'Existing and pmposed utilities <br />•Property Lines 'Outline and dir . ,� � <br />•Centedine ot street •Indicate •g changes" ,•Show measurements ' � <br />,SITE BELOW THIS LINE� ! , <br />PERMIT CONDITIONS: � `. + % <br />1. All calls for inspection shall . _4 hours in advance - phone 259-8810.:- ; i l <br />2. All work shall be performed in . ,rdance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. CaII Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�t �Z�K,M�l�1 -��v1CG he;C���-�,n -i'6�c, ���I.z, i���li��-vf-c.�a�� <br />� J <br />�(��,�j nui- exce� 4Z". <br />- . � �� � ��.. <br />5 <br />�( �n i w�u �`1 Se-� �rc.K� -�^1 �c(c e�� o-f- s, e <br />5�,��� �. sf��- <br />�w/�5l46 <br />/ <br />"�OD9b�57 <br />]TtiES: <br />CHECt; <br />� <br />/ <br />W <br />� <br />� <br />V♦ <br />� <br />O <br />� <br />� <br />� <br />r'^ <br />V♦ <br />� <br />a <br />3:O�F�f G�r,A#'O53 .:p::e <br />;^e.�;� <br />320.00 <br />ACKtJUWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save herm!ess <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installa�ion and maintenance of <br />ihe improvemenl cr olher right-ot-way use hereto applied for and turther agrees <br />to remove same upon notice trom the City a/nL to reo�ace p��b!ic property <br />damaged thereby. <br />, / .�- (� /� � � I . _ <br />COMPLEI'ION.TIHIS ERMIT MAY BE CANCEU.ED BY THE CINIUPON ANY S�TOPPAGE OF WO KI ON TH�IS PROJEC 0 ER 90 D�A SEDULRATION.Y PURSUEO TO <br />