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Date � 7 p y Pu01rt Woi�a Permil• [ <br /> AppliCelion For o�ea Deo�.• �IL.�'�l� �1-� <br /> I <br /> PUBLIC WORKS PERMIT P�°;o„FPeFCe S <br /> Less Rpol Fee Para S <br /> Print or Type Only ea�a�«o�� S <br /> 1�1t�� 5,.����In.�r,n 7��9 //,�,�ai/1,�f'rv � F_vo.iYfwrJ $�' S�Y� /.j�'t� <br /> Owner M iln�Aodres City Zip Phanc <br /> _��v�.1 <br /> Applicant Mailir.p Address City Zip Phone <br /> Describe Proposed Work �/'A.10�� <br /> ProjectAddress�ilknown) ]f�_f�],)(�l /Ci(f�pp /�L�Q � <br /> �7 � <br /> Atlach four(4)cepies of plans lor proposed work- Draw to scale and nole ihe tollowing as applicable: �� <br /> • Property Lines • Centedine ot street /w <br /> • Outline and dimensinns of all existing antl • Indicate North V� <br /> proposed structures on tt�e lot • Show any proposed grading changes <br /> • Esisting and proposed ulilities • Show measureme.As � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEqMITCONDITIONS O <br /> 1. All calls lor inspection shall be made 24 hrs. in advance-phone 259•8815. � <br /> 2. All work shall be pertormed in accordance with this permit and cwrent Clty ol Everett Design and Consiruction <br /> Standards anu Specilicatio�s. <br /> 3. Call Location Underground Service 48 hrs.6elore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �(JF�L/C. Lt�O/'.� F�F/�i>>lT �!/OT .F'FC�Ii•��'E.l� O <br /> j �P/� � � <br /> .��ic9,�r io vsE- F-r.s.—..v� .v v �//.�/B6 L <br /> � ( 1— <br /> ��/ � <br /> � <br /> a <br /> ACKVOWLEDGEMENT OF CONDITIONS <br /> The untlersigned owner/applicant hereby agrees lo hold and save harm� <br /> less the City of Everelt Irom any and all claims lor damages, ccsts. <br /> expenses, or causes ef aclion Ihat may arise because ol installalion <br /> and maintenance ol lhe improvement cr other right-obway use hereto <br /> �pplied foi and lurther agrees to remove same upon notice Irom ihe <br /> Approved lOr Construction Date City and lo replace publiC property damaged Ihereby. <br /> FIIJAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> evcmtt PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 320LCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.Wp 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'! BE <br /> Phone: 259-8815 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />