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H <br />Ca� H <br />y CA <br />3t <br />HZH <br />k W <br />H 0 <br />i"ii F1't <br />rn H <br />MH <br />O H a <br />HOCx1U <br />0. O <br />H <br />ZH <br />9H <br />Cie <br />HH <br />0 tz) fH/1 <br />tr+t <br />7; i-3 ti <br />HOrn <br />1 r+ <br />qlass, asks, <br />ri i <br />�S 1 <br />Date _(1-llL_� ,�Pny- la PoS7,FLa) Public Works Per &7— 7 <br />61dp.Depl.a <br />Application For <br />--- <br />bric Walks <br />Total FeeFea S <br />PUBLIC WORKS PERMIT Fab <br />Less AppLFasPaid S <br />`— <br />Oaiance Dua S <br />Print or Type Only <br />j Tom flkl , 3► d A 324 -5=MW <br />, zip Phone <br />Owner Address City? <br />�Maailling <br />�y� �� f�, � �7� <br />I /I iT /���1(- tt < l �.i ! q c o I c� —'9 r1I <br />II�CA/YA <br />Applicant Malling Atlaress Cny Zip Phone <br />Describe Proposed Work <br />WI <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work -Draw to scale and note the following as a icable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE 01/16/90 4:18PN 00011119554 <br />V <br />PERMIT CONDITIONS U00030114 <br />1. All calls for inspection shall be n•sde 24 hrs. in advance • phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett DesidWrr40ons6IiblS M <br />d <br />Standards and Specifications. �{{��p(�,' S$999.28 <br />hrs1before NUMBER 1.800-NA55 <br />Call Location Underground Service 48 you <br />z <br />(3. �dig..TOLL ,FREE <br />✓lam .�%�_�.,.,.� 6....z/.�g� . o,�y 9�lwz_xleo) <br />s 41e ,P n iJ. 7ruaa � �:&4 64.45— <br />CIO <br />4.�V <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation i <br />maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />p v d f s ruc j' 1e City and to replace //public property damaged thereby. <br />INAL INSPECTION Date <br />pproved as Constructed <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLICWORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett WA 98201 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8810 PROJECT OVER 90 DAYS DURATION. <br />t, • i t <br />- L. <br />