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� <br />� <br />TYPE OR PRINT ONLY <br />ppDlicalion For <br />PUBLIC 1PVORKS PERMIT <br />PUBLIC VJORKS DEPART�".ENT <br />32J0 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />Date 8 -/ 7 - 99 � <br />Public Works Permi� q <br />Building Permit q <br />�39_ <br />5b <br />Public Works Fee S �� � <br />BP <br />/la��� h�,i1Q� <br />Owner Mailing Address City "Lip Phone <br />rG .� <br />Applicant <br />Describe Proposed Work <br />�ec�l <br />PROJECT ADDRESS (it known) <br />Zip Phon� <br />Attach four (4) copies plans for proposed work - Draw to scale and note the following if applicable: <br />• Property Lines • Outline and dimensions of all exisling and proposed stmctures on the lot • Existing and proposed ulilities <br />• Centerline of slreet • Indicate North • Show any proposed grading changes • Show measuremenis <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. Ali cails for inspection shall be mede 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with ihis permit and current City of Everett Design and <br />Construction Standards and Specifications.. <br />3. Call Location Underground Service 48 hrs. be(ore you dig. TOL!_ FREE NUMBER 1-800-424-5555. <br />� �� �;�y s����:f� <br />� �vo,e,� fo � �one <br />g�� � L, e d S� P'�Gl, <br />_SNC ���,-.� o,�pz� L;z <br />CI�Qh �� alL fii�-,es <br />/h 4nea- .S/�oc✓n pn 7�e <br />,�, �'_�ew-�.-- �-2 a - a o <br />AppAovedsas Cons�tNcted Date <br />Z.S — <br />W <br />r <br />� <br />V / <br />� <br />V / <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />ihe Ciry rl Everetl trom any and all claims for damages, costs, expenses, or <br />causes of action that ay arise because ot installation and maintenance of the <br />improve or r right-of-way use hereto applied tor and further agrees to <br />remo sam n notice fmm the Cily and to replace p lic pro rty dam• <br />ag �here . <br />�'��!� <br />WOHKAUT}-IORIZED BYTNIS PERMR MUSTBE STAR'TED WfTHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFlER IS TO BE DILIGENR.Y PURSUED TO <br />COMPLETION. T1'iIS PERMR MAY BE CANCELLED BY iHE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS DURATION. <br />