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Date G LLa—Ay Pubo,Woer.P.rm� <br /> Bldg Door <br /> >pplludlon for <br /> PUBLIC WORKS PERMIT P"°lour°'x'Fog <br /> • <br /> Tocol Fee <br /> Le.o.ppl F..Pold 6 <br /> al No <br /> Print or Type Only <br /> lR-�'a�e ��u .S'n:J �S�/7- �`%7T%l� �o/G+-✓l /c �".4/�.�- `-i��,S:Z G 9/• "7�'�� <br /> owner <br /> Melling Address City Z Phone <br /> " !SMGPhone <br /> -Mailing AAC,esa Cily ZAP <br /> Applicant <br /> Describe Proposed.Mork <br /> W <br /> Project Address(If known) y' (p O"- �J.• _ <br /> Attach lour 141 copies of plane for proposed work• Draw to scale and note the following as applicable: <br /> arae <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 Im <br /> DO NOT WRITE BELOW THIS LINE 0 <br /> PERMIT CONDITIONS � <br /> 1, All calls for Inspection shall be made 24 hrs.in advance-phone 259-8815 <br /> 2 All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificatlons. <br /> 3, Cell Location Underground Service 48 hra before you dig TOLL FREE NUMBER 1•800.424.5555. <br /> d <br /> O <br /> of <br /> n <br /> Q� V urL 0 � ) <br /> � f <br /> ACKNOWL D EMENT OF CONDITIONS <br /> The undersigned oN-ler/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, coelIL y r <br /> expenses, or causes of action that may arise because of installation �G <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 /> Approved for Construction Date City and to replace public property damaged thereby. <br /> t7e r l <br /> tW <br /> FINAL INSPECTION Dale Date 1 <br /> Approved as Constructed Signature of Applicant I <br /> MIT MUST BE STARTED WITHIN <br /> WORK AUTHORIZED BY THIS PER <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 1S TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS r <br /> Phone. 259.8815 PROJECT OVER 90 DAYS DURATION. <br /> i. <br />