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i <br /> Pubo.Wont°Permit• <br /> I —T-7— <br /> Application For Bleo Depr.• ..�_. <br /> PUBLIC WORKS PERMIT °�TotaFee°°° <br /> Leet•ppl Fee Paid S '^ <br /> Print or Type Only Balm's eve • <br /> 1�VD_r�sn�s fs,cc Il cf�4 o j( ��u a„ Po !finx �1dv 6 J?,0&4I/Nt <br /> 1-•v er Melling Addres City Zip Phone <br /> Sa114e wlr UIIr/rh &41—&7" <br /> Applicant Mailing Address City Zip Phone <br /> Describe Propoaud Work N PtAJ u iii P h <br /> Protect Address(if known) _ 7iz Foil 11 8 — GO <br /> Attach four(d)copies of plans for proposed work• Draw to scale and note the following as applicable: s� <br /> s • Property Lines • Centerline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate North v♦ <br /> j proposed structures on the lot • Show any proposed grading changes <br /> 0 Existing and aloposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 firs.in advance•phone 259.8810. Irs� <br /> 2.All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 firs.before you dig.TOLL FREE NUMBER 1-800.424.5555. <br /> M Ur <br /> M v <br /> r0' <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hand and save harm- <br /> less the City of Everett from any and all claims to: damages, costs, <br /> expense . or causes of action that may arrsi because of Installation <br /> � /� 3/.�../ mal nonce of the improvement re or v other right-of-way notice <br /> use hereto <br /> 07sj�y SY a Ie and further agrees to remove same upon nollce from the <br /> Approved for Cot. ctl in - ate 0 y p r place public property damaged thereby. <br /> i �o-moi "Pi _ <br /> FINAL INSPECTION Dale ' <br /> Approved as Cwistructed SIB at re I plirant Date <br /> Pvl•rrtt PUBLIC WORKSDEPARTMENr WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 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 <br /> D <br /> Phone:269.8810 PROJECT OVER 90 DAYS DURATION. <br />