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1Do2s - q� /��, �� <br />� <br />TYPE OR PRINT ONLY <br />Appli:ation For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Evarett WA 98207 259-8810 <br />T� POSTiNG N�v 1 s zoor <br />' Msiling Address City <br />� /oZ C� S. W. E r����71 �F <br />MailingAddress M� �,,�qt, iry <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />N <br />.��a -�_ � <br />Date <br />Public Wcrks Permit p � zZ <br />Building Permit p <br />Public Works Fee $� S� 7 __ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note tne tollowing if applicable: <br />'PmpeAy Lines 'Outline and dimensions of all ezisting and proposed structures on tha lot •Euist�rg and proposed utilities <br />•Center�ine of sireet •Indicate NoAh •Show any proposed grading changes •Show measuremenis <br />DO NOT WRITE BELOW THIS LINE <br />PERMiI' CONDITIONS: <br />1. 'rll calls for inspection shall be made 24 hours 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 Lecation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />� C Or� �r�a � fO/- 7�i" f,%i�,I �%o�j /r�u5� wor,E Lvi �� TiJ � <br />Ci�fy pu6l�� evor,Fr /hSPecfar �o pravi�e a, fi�aFr�:c <br />�vhf�oL f�4�� , <br />,,:�.:7;��rr ;:�:__,- -. - <br />S. /�l/a�-�E �a bt a�cnz P�r af,o. •or�e� C�v,l ;,,a <br />� A,. !09��_�. <br />�Lwi� ��fed 'Y�a—�� G//.a/g6 ';JiS=V 5",'- . <br />� '6�.� ��'.`�i `o'. _.... <br />l <br />Approved as Constructed <br />ACKNJWLEOGEMENT OF CONDITIONS <br />The undorsigned owner/applicant hereby agrees to hold and save hartnless <br />the City of Everett (rom any and ail claims for damages, costs, expenses, or <br />causes of actlon that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hareto applied for and further agrees <br />to remove samo upon notice trom the City and to replace public property <br />3 i�-9� <br />WORK AUTHOfiIZED BY THIS PERNIT MUuT BE STARTED WITHIN 1 BO DAYS OF DATE PERMITVS ISSUED AND ThcP.EAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLE710N. TH�S PERMIT MAY BE CANCELLED BY fHE CITY UPON ANY STOPPAGE OF \NORK ON fHl� PROJECT OVER 90 DAYS DUR4TION. <br />