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Date��� <br />% � PUBLIC <br />Print or Type Only <br />�e �se � �os. <br />Owner <br />' / /I.f� � <br />Applicent <br />Describe Proposed Work <br />�. <br />: <br />Appiicetion F�or <br />WORl�'S <br />O <br />$ <br />. � <br />c. <br />Meiling <br />PERMIT <br />8 O <br />2 � S'c <br />�Q OSZ¢ <br />� c�y <br />i�-ifr�lL �. <br />y� i// ; � <br />P�nhc WorMs Permit • <br />elag. Dso�- • <br />puohc Warb Fae s <br />Talsl Fee <br />Leu Appl Fee PaiG s� <br />Belance Uue S �0 � <br />007- 3zzyo / 7d.i / <br />9�io7 <br />E <br />�7g3 -s-�� <br />P�' <br />C27-9,s�G <br />Project Address (il known) / / � " ' � �' � """' ' — — <br />a�fach lour 141 cooies ol plans for proposed work • Draw to scale and note ihe following as applicable: <br />• Property Lines <br />� Outline and dimensions of ell existing and <br />proposed siructures on the lot <br />• Existing and proposed utili�ies <br />• Centerline of streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measur?ments <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be mede 24 hrs. In edvence • phone 259-8810. <br />2. AII work shall be peAormed in accordence with this permit end current City of Everett Design and Construction <br />Stendards and Specitications. <br />3. Cell Locetion Underground Service 48 hrs. before ycu dig. TOLL FREE NUMBER 1•800-424•5555. <br />/ /�Q�`Q[C Gs//� SQvnC SiG� p,$��a� QS GY'�/na.� <br />. � <br />p.P:n9 . <br />S �,pP Cj�/ S��'���%1' Clee,�. .ritalL �'•rneS, <br />��r�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Streot <br />Everet6 WA 98207 <br />Phona:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ov.�ner/applicant h� reby agrees to hold and save harm• <br />less the Gty ol Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that rnay arise because ot ins�allalion <br />and maintenance oi ihe improvement or other right•of-way use hereto <br />applied for and further agrees to remove same upon notice Irom the <br />City and to rep�ace lica�e#�rry damaged thereby. <br />_ <br />' �O <br />Signatu p icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE�ION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />