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Date <br />TO POSTING.11L/-c,C <br />ApplicationFor <br />maa Deu <br />PUBLIC <br />WORKS PERMIT <br />oto...^iee s <br />ill. AIM i.. P.4 <br />Print or Type Only <br />//L�JGrcPieiG=;S 10,76 IO�Sf <br />.Ev e j97—D' 339-2— 0 <br />Owner <br />Mailing Address City <br />Zip Phone <br />SkMI, <br />Applicant <br />Melling Address <br />Zip Phone <br />Work <br />,city <br />Describe Proposed <br />ab 14, <br />W <br />vau (' ' <br />Prolect Address (it known) <br />Attach lour (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 <br />'A <br />v+ <br />proposed structures an the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />M <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />1. All cells for Inspection shall be made 24 hrs in advance • phone 258.8815. <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 Ins before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />Z <br />/criJ�S �scT /��'%/f/ inJ Si!%1i'�6 d'% <br />Ty conlcJii <br />/�CccrJ<iifiG tD'CiT yv� .u�/T•� Toj <br />��/� <br />-' wo �) ,��t�Sp E9Sr�c r1� 72> 6rrPT �A�NC'.5-. <br />a <br />,r 0. �. o,�r <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />//� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />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. o uses of action that may arise because of installation <br />is -way anc t 0 more ant or other right -of <br />use hereto <br />epp <br />nd f that gra^ 1 remove same upon notice from the <br />Oily d 1 la pub) pm if damaged Ihereuy./// <br />rA 1 g/s/g / <br />Signature of Applicant ( �e,v <br />WORK AUTHORIZED BY THIS PERMIT MUS BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 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 DAYS DURATION. <br />