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M p <br />x <br />❑ H <br />9Hcn <br />I­4 1-3 C3 <br />0=0 <br />Fit H rV <br />Hzrr <br />orrr, <br />H G <br />I- b7 0 <br />0. 0 <br />9 H t7 <br />tHH <br />COat7to <br />HOC4 <br />! !1 <br />Date o <br />Application Ford, <br />PUBLIC <br />WORK PERMIT <br />a <br />O <br />Print or Type Only <br />o n u n <br />0 000 <br />,tea, o0 <br />Public WorxsP fMit <br />rNq. Derr <br />PublK Woirs Fce <br />Telel Fee S — - <br />Less APPI. Fee Peed 5 <br />ermnce nue S -- <br />Owner Marling Atl(esso 0 0 co s (ylty Zip Phone <br />co <br />r AlatJ e0rP.eo .for, '�r I�1Vl _ WA 919009 4f <br />Applicant fh 6cor 5'kfw1Q11a,l,ng Address City Zip Phone <br />Work <br />I L( <br />Z <br />Project Address (if known) <br />Attach four (4) copies of plans for pl`06s'bd J+bik --Dray <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exiting and proposed utilities <br />scale and note the following as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259.8810. <br />e. 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 1-800.424-5555. <br />,za,uaoy�j <br />�Approvr C stru lion .' Date <br />FINAL INS E TIO Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 99201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />0 <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 mainte nce of the improvement or other right-of-way use hereto <br />applied for furth grees to remove same upon notice from the <br />City'and publjo property damaged thereby. <br />WORK AI�THORI#D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAY OO� GATE 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 />