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S t0"'H-7 <br />J0 <br />9 <br />H zH <br />H <br />NH <br />q17 <br />OH <br />GHMO9Hz <br />rHH <br />H <br />Cd� <br />Mm <br />z H rn <br />H o In <br />- <br />L— 32 _z) _5 <br />5 t <br />//�� <br />Dale /7,-719I <br />Pubhc Worhs Permn a iO <br />/ <br />i <br />Application For <br />Bldg Dept a ,„jp,�_ <br />PUBLIC <br />WORKS <br />PERMIT <br />PebTdelrae Fee <br />POSTING 3 �z/9� <br />Lee&Appr Fee Pnd $ __ <br />Print or Type OnIT <br />000 �� <br />TO <br />aIance Due <br />r6 <br />rrt ." a <br />rn rI <br />11 <br />tin w o na <br />e1 M <br />ti <br />yip— <br />fevem if 4cP2,v� <br />ZSZ— ZSO� <br />caner <br />W <br />City Zip <br />Phone <br />O <br />QOU�W JU1�O <br />U_t <br />V1 r , I�� <br />f— <br />Applicant <br />Mailing Address <br />City Zip <br />Phone <br />Describe Proposed Work <br />N gl) U4A/e <br />7p�hmdy <br />Of ID1/d [ ff <br />Project Address (if known) <br />— S. 4TH AVE <br />Attach four f4) 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 o' all existing and • Indicate North <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 <br />1. All calls for Inspection shall be made 24 his. 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 1.300.424.5555. <br />�. Keep cif-) r,Lreel3 clean aL all (:iFnCi. <br />f) <br />Date <br />W <br />liji"Bill <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, or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-of-way use hereto <br />ao lied for and further agrees to remov me upon notice from the <br />ON"end to replace public property d aed Ihereby. <br />nature of Applicant Date <br />everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Phone: 2598R10 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />