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Date 5/7/0.2 Public Works Permit# ,91,+/73 <br /> '\. <br /> Application For Bid9,Dpt.# i , ! <br /> • <br /> PUBLIC WORKS PERMIT PublicWorksFee <br /> Total Fee 4. <br /> k Less Appl.Fee Paid <br /> Balance Due <br /> Print or Type Only <br /> AAoy P/D, <br /> Owner Mailing Address City Zip Phone <br /> k.S,9 F <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work / erg. /5-.2c'7 7 i .. - v'L r7-1+-p�.2,• <br /> ` 4 <br /> MNIIIIMMIIII <br /> �/�)C� W <br /> Project Address(if known) 11.11.11 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <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 <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> y et,,,,,„....4.,, ,,,,,,,..., ..„..„, -zee—4, 46-4-, 0 <br /> 4.17.-_;-e, -4 12Z 1111.1111 <br /> � ....-A-Irel � CO <br /> 0 <br /> as <br /> TA L k e 1) (A)( 7A-LL672 - .7R-e-e --o 4-c. <br /> 1-0i '\ Cloumct& VY0-1-1--t n <br /> d a -d o h c/7 <br /> -06'off. A5 0Lzl (-)/trA -D 0ii Plan' ACKNOWLEDGEMENT OF CONDITIONS <br /> 4. <br /> -4 Cr /y /v 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 <br /> OZ,' and maintenance of the improvement or other right-of-way use hereto <br /> Yam'=- Me') <br /> applied for and further agrees to remove same upon notice from the <br /> Approved f onstruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date - 5 —, <br /> Approved as Constructed Signature ppl- nt Date <br /> i" \ WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everette PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200tt,WA9 Cedar treet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> J Phone:259 8810 PROJECT OVER 90 DAYS DURATION. <br />