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Date 9/2/93 <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />I�F. <br />Ci�y <br />PUGbc Wo�kf Perm'il � 41910 <br />Bltlp Deo�� • <br />Pubi�c Worka Fen s <br />Tolnl iee <br />LP55 AOO� FxP P0�4 S <br />Bela�ra Dun s <br />I_19I.Z •,nY41 <br />Phone <br />OWrter — Phone <br />Applicant Mailinq Address Crty Zip <br />Describe Proposed Work <br />New del'ached <br />Project Addiess pl knownl %08 Giand Ave <br />Attach four 141 copies ol plans lor proposed work � Draw to sca�e antl note Ihe lollowing as apphcabie: <br />• Proper�y Lines <br />• OulGne and d�mensions ol all exislin9 and <br />proposed sVuctures on the lot <br />• Existing and proposed utilitles <br />• Centedme ol streel <br />• Indicate North <br />• Show any proposed yrading changes <br />• Show measurements <br />P�RMIT CONDITIONS <br />t All calis for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work sha�l be pedormed in accordance with this permit and current City ol Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Loca;ion Undernround Service 48 hrs. before you dig. TOLL FREE NUMBER 1•SOO-424-5555. <br />PUi:LI�„ WORKS PERM17 <br />NOT REOUIRED <br />^Y�,J/' <br />c�nTE ` i3 <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Apnroved as Construcled <br />�� PUBLIC WORKS DEPARTMENT <br />,��E/ 3200 Cedar Streel <br />Everett. WA 98201 <br />Phone:259�8810 <br />ACK^lOWLEDGEAIENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unUers�gned owneUappliCant hereby agrees to h^Itl antl save harm� <br />less the Cdy ot Everett Irom any and all claims lor damac�es. cosis. <br />e■penses. or causes ol action that may anse because of mstallation <br />and mamtenance ol the improvement or olher nghbol-way use hereto <br />�pphed br anA �urthe� a9�ees te remove same upon noUce from �he <br />C�t} :u�C lo �eplace public properi)' Uamaged �hereby. <br />S�u��aWre ol APPl�cant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED W�THIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER iS TO <br />BE DILIGENTLV PURSUED TO :OMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />