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i <br /> �8tQ3L/1X , Public Werke Permit• pp..A <br /> Application For Bldg Dept a pa <br /> PUBLIC WORKS PERMIT Publitotal <br /> FeeFN <br /> WFee S <br /> Less Atilt Fee Paid S <br /> Print or Type Only Balance Dua �j <br /> h AtE <br /> IIliir qrM wner mailing dAddress 1�okjllmCity aIB Z <br /> t Applicant Mailing Addressssls City Zip ,lint/ Phone <br /> Describe <br /> Describe Proposed Work (,.1.1L �.L�( d � <br /> W <br /> Project Address(if 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 /A <br /> • Outline and dimensions of all existing and • Indicate North v� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for Inspection shall be made 24 hrs. In advance-phone 259-8815. �ss� <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 hra before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> JiYE /Yle?X/invm WiIJTiY Fig19 /EES/pFvr�aG !�c%vricl/J'/ <br /> as /S 20 106C Cir <br /> (n A /0 O <br /> �D N� <br /> u , ),0)",�k a <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 /> expenses, or nausea of action that may ether because of installation <br /> end maintenance of the Improvement or other rignt•ol-way use hereto <br /> applled for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to <br /> replace public property <br /> /modamaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as ConstrUClBd . Ignature of Appliqdnt Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ev� r S 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar <br /> Everett, da 9 tree BE DILIGENTLY PURSLte:D TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 269.881 b CANCELLED BY THE CI1 ;UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />