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mix <br />9 H CA <br />H E z <br />oxo <br />tsJ H 'it <br />ti H <br />05 <br />CJ <br />Hoo <br />MO <br />0. Ci <br />H Qgg <br />9 F3 <br />t HH <br />0 � <br />O H <br />C] t:7 fn <br />M <br />z H En <br />F3Orn <br />+1 Wall" <br />r <br />DatesyroSeJ_�9 <br />PUBLIC <br />0,;. + -, Tvr a n n lv <br />Applic@tion For <br />.-1 <br />WORKS PERMIT" <br />C2 <br />O m Cal O <br />Public Works Per _. <br />Bldg. Dept. <br />Public al Fee Fee <br />TF <br />$ /C) <br />Works <br />�—�=�� <br />Less Apol Fee Paid �l) <br />Balenco Duo $ <br />Describe r VG► L I ► i ►y� <br />Project Address (if known) <br />/nt <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 • Show measurements <br />PERMIT CONDITIONS <br />1. 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. Cali Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />everett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 99201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />tow <br />z <br />U) <br />O <br />an <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-ol-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 />5 za <br />Signatu,0 of Applicant uate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 1S 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 />