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Dale -s 1" c5'6 <br /> Pubhu Works Permit• !? <br /> Apphcnhcn For Bldg cold • 6 v (/S <br /> PUBLIC WORKS PERMIT Public IV, Fea <br /> Toul Fee S <br /> Less ePPI Fee end S _ <br /> Print or Type Only l Baian<e pug S 2 <br /> �1//y.9L Ei✓ __ %?�_ 262 `>7�t/,eO6 O <br /> Owner Melling 80X Address <br /> City ZIP PhenC <br /> S9fi6 <br /> Applicant Matting Address Ciry Zip <br /> Phonn <br /> Describe Proposed Wo-k hC/PC.CX <br /> Ual <br /> Project Address(if known) LOQ"C �p�fC— .JB y Pe SE _ <br /> Attach four I41 copies of plans for proposed work-Draw to scale and note the following as appllceble: <br /> • Property Lines s� <br /> • Outline and dimensions of all existingand • Centerline of street <br /> • Indicate North <br /> proposed structures on the lot • Show en <br /> • Existing and proposed utif les y Proposed grading cha ines Cn <br /> • Show measurements <br /> 00 NOT WRITL BELOW THIS LINE 00 <br /> PERMIT CONDITIONS o <br /> 1. All calla for Inspection shall be made 24 his.In advance-phnne 259.8815. <br /> 2. All work shall be performed in accordance with this permit and current City of <br /> Standards and Specifications, Everett Design and Construction <br /> I <br /> 3. Cell Location Underground Service 48 bra before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> r O <br /> C6 <br /> CL <br /> e <br /> ACKNOWLEDGEMENT OF CONDITIONS <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. costa <br /> ��Oc✓+'e 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 /> Approved for Construction Date applied for and further agrees t0 remove same upon notice from the <br /> City and to replace public property dam ed thereby. <br /> FI INSPECTION Date r <br /> Approved as Constructed Signature of Applicant <br /> Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORN ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />