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Date�� I � <br />PU��LIJC <br />�r <br />Print or Type Only <br />Describe Proposed Work <br />�lpohcahon For <br />WORKS PERMIT <br />Mading <br />City <br />Lip <br />Prolect Address lil known� JIGL//] /�{li�r—�!'✓ � <br />Attach lour (Q) copies of plans lor proposed work � Draw ro scale antl note Ihe follewing as applica0le: <br />• Property Lines <br />• Outline and dimensions ol all existing antl <br />proposed struclures on the lot <br />• Existing and propo5ed utilities <br />�YD�K WO��� 0llmi� � /� / <br />emc o.a.• 9n,�yQS — <br />Pup��t W[r�f �•e <br />O�al F<n 5 <br />;�.. ,00� .« o„a s <br />9a�ance oue 5 �� l <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />YhOn �� <br />�C � <br />Phone <br />PERMIT CONDITIUNS <br />1. All calls for inspeclion shall be made 24 hrs. in advance � phone 259•88� �. <br />2. All work shall be pedormed in accordance with this permd and wrrent City of Everetl De::ign and Consiruction <br />Slandards and Specifications. <br />3. Call Location Undergro�nd Service �8 hrs. before you dig. TOLL FREE NUMBER 1•8C0�424-5555. <br />`t ����1"Il`�,��. 3/2� f � <br />Approved for Conslructinn Date <br />FINAI INSPECTION <br />ApProved as Constructe:: <br />overett PUBIICWORKSDEPARTtdENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8810 <br />Date <br />%'l��1�-7> <br />�k C��i� <br />� Lb) '� c d�`-`�i <br />��li�� ���° !�/ �. � <br />� L' _ I <br />�G.7` ��L<�/.�EC'r7���v �,<l/ . l ^� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />N <br />� <br />O <br />♦�^ <br />V♦ <br />O <br />a <br />The undersigned owner/applicant here�y agrees to hold and save harm- <br />less the City ol Everett from any and all claims lor damages, cosls. <br />expenceo, or causes ol action thal may arise because of installation <br />and maintenance of the improvement or other righi�o4way use hereto <br />applled for and �uriher agrees to remove same upon notice irom the <br />Cily and to replace public property damaaed the�eby. <br />Signature ol Applicam <br />Date <br />WORK AUTHORIZE� BY THIS PERMIT MUST BE STAFTED W�THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />