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< z. /0/93 TO POSTING 12-2L <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pupbc Works Perm" • Sv o <br />Bodo Dept e <br />Publ¢Works Fee S <br />Total Fee <br />Less Atilt Fee Paid S a On <br />Balance Due It <br />ov Z --3a2Vell 79 3 / <br />vkr"�. <br />/J/1'1 ✓•✓die � <br />2L/ 1j2n Si iPD 4L� 9s?�3 l S2 <br />Phone <br />-7c / <br />Applicant Malang Address City Zip <br />vor, <br />Describe Proposed Work 7F1z <br />0 <br />A/ <br />W <br />I�O / <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Centerline of street <br />• Property Lines <br />• Outline and dimensions of all existing and • Indicate North <br />• Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />M <br />W <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />with this permit and current City of Everett Design and Construction <br />2. All work shall be performed in accordance <br />Standards and Specifications. <br />Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.555 . <br />3. Call Location <br />�/�. '%y/GC� w�fh /ov6L:"a woes L�s�ccfo� 6¢Fo�t <br />O <br />`r7�7r.fn S. Gt/r7/'�E <br />'2�1�`''fL /A�93 <br />Approved for <br />�conjstru on Date <br />N <br />3 <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees 10 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 />applied for ar(dlurther agrees to remove same upon notice from the <br />City and tq Tepl aa e public property da rnage'�hereby. r _ <br />oly� �o,.`J.......'__. <br />WORK AUTHORIZED BY H SPERMIT MUST BE STARTED WITH <br />IN <br />180 DAYS OF DATE P 1 IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSU 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 />