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Date % I B' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1oh1 LN7)LA sr lozc 10`` Sir <br />em Mailing Add ress City <br />Describe Proposed Work C L-ILA 12-1 <br />Project Address (if known) <br />ryUr¢ Wort. Perm-1 • � J 7 2-6- <br />mev ocor. <br />recta wax. re. S <br />Tm.r tee <br />Les. A,.1 h• Prix S <br />B.I.M. ev. s 35�21 <br />,an _ r voq_oGA>r� <br />Attach lour (41 copies of plans for proposed work • Draw to scale sort note the following as applicable <br />• Properly Lines • Centerline of street <br />• Cutline and dimensions of all existing and • Indicate Ncrlh <br />proposed structures an the lot • Show any proposed grading changes <br />• Edsting and proposed utilities • Show measurements <br />PERMIT.:ONDITIONS <br />1. All calls h.- Inspection shall be •^^_as 24 his. In advance • phone 259.8815. <br />2. All work shall }e performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and J;ncilirn!,ons <br />3. Call Location Underground Service 48 lira. balers you dig. TOLL FREE NUMBER 1.800.424.5555. <br />tS6F-" /i'77iiCHF� QCgN �'i7.f CLEAR/n/6 L/in/Ts, <br />f«.Et' Liry S�i_•.E.F7-T' CLEgi✓. <br />07/24/E7 IS:IBRM 000AN[ <br />uoDososzs <br />DPT.2o sa5.00 <br />CHECK '.75.01 <br />ACKNON LEDGEMENT OF CONDITIONS <br />W <br />I- <br />LPJ <br />Cl) <br />O <br />IL <br />The undersigned owner, applicant hereby agrees to hold and save harm <br />less the City of Eve of Irom any and all claims for damage. costs, <br />ex es, or that may arise because of Installation <br />r me anon o the prove enl or. oilier righ4ohway use hereto <br />ap Ile for end 0 er goes t remove same upon notice from the <br />Ci y an to r 1 e p�bli props y damaged iherehy� _ <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT RY. AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />c�omu I 0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IB TO <br />3200 Cedar Street B DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />i <br />Phone: 59 HB15 PROJECT OVER 90 DAYS DURATION. <br />