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N�yy� <br />ID #!x <br />Q H <br />�xHyx[n <br />tHYM <br />"�✓d M ail <br />N H <br />z <br />OH <br />HM <br />9 F3 <br />tgyy <br />c]C1� <br />t7 <br />HOytig <br />Date <br />AppliCnlion Fo, <br />PUBLIC WORKS PERMIT <br />T�(� <br />Print or Type Only O POSTING_ <br />Nbl'. Wore, PelmC• e)U/Z75 <br />Bldg Dept <br />Peel,c wore, Fie, S, <br />Total Fee <br />Leb Apor Fee Pall `S <br />Balance Due $ -n 00 <br />00? jZZ - yo—000-/7-83/ <br />en/ 7SS- Y60/ <br />x$i=7/79''- City Zip Phone <br />Applicant Meiling Addres9 <br />-T/75%LC �S"«er qnc/ !✓R�er SCrvi_Cu -- — <br />Describe Proposed Work <br />Lii GS 7`O LOt' 2COn S�n7c <br />feal <br />Project Address (II known) <br />Attach four (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 />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities Is Show measurements <br />PERMIT CONDITIONS <br />I.All calls for inspection shall be made 24 hrs, 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. Cell Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />Can f .Oee�v.f�w r v )W2, <br />"'2pe4� <br />g,' �,LrGu,y Ltt���orv, <br />7; lug✓ GGsn� � i �fG, s is t lu a w l/1�4 G y <br />Approved fortonstr lion // Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1= <br />NM <br />ca <br />0 <br />sl <br />0 <br />♦r <br />Y/ <br />0 <br />a <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 />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />. _ / Z,Zi/ <br />ate <br />Signatur of Applicant <br />WORK AUTHORIZED BY THIr4. ERMIT MUST 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 />