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Date—.LW/ S9 n ry w...ewmn. 8 1—p2.4 <br /> Ann Lea L en for e-rp p.nr A —7z— <br /> PUBLIC WORKS WORKS PERMIT P.11;1.11.1 <br /> re• -- <br /> t...AMi rM rh,E <br /> Print or Type Only <br /> aZLI .- [f)A-1 � DP�elo,Tn4A,r 1�7 &-IX 4ny) 6 JgLIIPIyTA 9d'a7S ! y/ � _ <br /> Ow ei ming Address City zip Phone <br /> Saµ1 � CDY!fG1T/ Si'5i Ullnith <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work kip cu a. P tp r — LOT"gyp fAWS7D OQ / d' 3 i/ <br /> Project Address pl known) L <br /> Attach lour 141 copies OI plena for prOp0ae0 work•Draw l0 sca a and note the lollowing 08 applicable, <br /> • Property Lines •Centerline of street <br /> •Outline and dimensions of all e.elfing and • Indicate North <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 <br /> PERMIT CONDITIONS O <br /> 1.All cane for Inspection shall be made 24 fres.In advance•phone 259.8810. <br /> 2.All work shall be Performed In accordance wllh this permit and current City of Everett Design and Conalruction sal <br /> Standards and Specifications. <br /> 3.Call t.ocatlon Underground Service 48 fire before you dig TOLL FREE NUMBER 1.800.424.5555. Z <br /> � <br /> r/ <br /> C <br /> O li <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees 10 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 /> !, yCp�_� /�n an einlenance c, the improvement or other right•ol•way use hereto <br /> ep i d f a lurlher agrees tp remove same upon notice from the <br /> Approved for Construction —�Da <br /> Cit e d b r ace public property,damaged the It <br /> L INSPECTION D /1 <br /> Approved as Constructed SignAtuFAINAeplicant ,Dale <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE ARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15 TO <br /> Everett WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY DE <br /> Phone:2898810 CANCELLED BY THE CI IY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION <br />