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Date� //NJDf• Bldg Darl <br />V Application For <br />PUBLIC WO R KS PERMIT ilcWorP"° "° : — -- <br />"' <br />len xcP' r.• rind $ <br />H•lencn Du_ $ <br />Print or Type Only <br />1� <br />�L/UWner ( f <br />JJ <br />`I CItY ZiP <br />Applicant Phone <br />Mailing Address <br />C - C� <br />Describe ProAL posed Work ( e <br />W <br />39 i 9 - R'094z. <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work -Draw to scale and note the eniterline of street able: 0 <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />prrposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />ID <br />DO NOT WRITE BELOW THIS LINE 0 <br />PEPMIT CONDITIONS �\ <br />1. All calls for inspection shall be made 24 hrs. in advance •phone 259.8815. i <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Conniructlon <br />Standards and Specifications <br />5. <br />3, Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER i •800.42A•'55 <br />/UCH ��r"/riN6NT STiC'GC TGf CES /� 4'E TO BE O <br />Cu�J-� 7.CvcTer� H <br />C0 <br />O <br />0. <br />ate <br />ADpr0Ve�ruC110n <br />FI PECTION Daie <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAP.TMENT <br />3200 Cedar Street <br />Everett WA 982018201 <br />Phone: 259•8815 <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 in tallation <br />and maintenance of the Improvement ore !her aemelg noo nn Ycese hereto <br />l rem the <br />applied for and furth r 1191aaa-lin rAo1o,ged thereby. <br />City 8J;elyt�pifi: property / f <br />RTHRIZED BY THIS OF DATE PERMIT ISESSUED AND THEREAFTER ISRMIT MUST BE STARTED TO <br />IN <br />180DAYS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />