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Date <br />Appllutlo• r <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />0 <br />Dsecribe Propoeed Work <br />./� �� — �,�.' <br />Pro�sct Addreea (if known) <br />� <br />ci�y - zio <br />City Zlp <br />•i,b . 1 � <br />Atlach four (4) copiea of plans tor proposed work - Draw to scale end note the following as applicable: <br />• Property Linee <br />• Outline �nd dimenelona ol all exiatinp and <br />propossd atructurea on the lot <br />• Exletinp and proposed utilitiea <br />PERMIT CONDITIONS <br />vwwc wona r.�n • <br />!MF DW�. � �_ <br />PuEMe Walu Fw <br />Tot4 Fw / <br />L.0 �bol Fw P�a i <br />M4nc� Du� i <br />• Centerline of street <br />� Indfcata North <br />• Show any proposed gradinp chanyea <br />• Show measurements <br />7. All calle for Inepectlon shell be rt�eda 24 hrs fn advance • phone 259•881 5. <br />2. All work ehell be pertormed in acco�dance with this permit end current City of Everett Desipn and Conatruction <br />StendaMe snd Speciflcetiona <br />3. Call Locatlon Underpround Service 48 hra. before you dig. TOLL FNEE NUMBER 1•800�424•SSSS. <br />�� �H �bl< < <br />Approved br Conetructlon Uate <br />FINAL INSPECTION Date <br />Approved �s Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259•987 5 <br />�/ P 2IC S (/�L�Ivn �� <br />����� <br />ACKNOWLEDOEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undaraigned owner/epplicant hereby aqreea to hold and eave herm- <br />less the City of Everett Irom any and all claime for dameqea cost0. <br />expenses, or cauaes of action that may erise because of Inatellatlon <br />and maintenence of the improvement or other riphbof•wey use herato <br />applied for end further egrees to remove aeme upon notice irom the <br />City end to replace public property demeqed thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERM1IIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS 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 DAVS DURATION. <br />