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late_I lCi C Public Worke Per • <br /> Application For Bldg Dept <br /> PUBLIC WORKS PERMIT ubTorsi Fee Fee 14 <br /> Leu April Fee Fields <br /> Bsis,ce Due s `� <br /> Print or Type Only <br /> p (c!i()� ��Illmctrnin SIF► ON?-C85R <br /> Owner Malting Address Clly Zip Phone <br /> Appliant Mailing Address City Zip Phone <br /> r <br /> Describe Proposed Wnrk J 41- <br /> W <br /> 1 _ <br /> Protect Address(it known) -7z0 — �� S'7_ S(�- H <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the following as applicable: <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 • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hrsin advance-phone 259-8815. M1 <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 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. z <br /> h21✓ArwA1 Cue& cars AeLr Ndr To 6-E- W40"eD O <br /> pe inovED <br /> N <br /> O <br /> 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 lot damages, costs <br /> .P6wlc✓!D w/t.e4,e;1ce4✓/ 10. expenses, or causes of action that may arise because of installation <br /> ire and maintenance of the Improvement or other right-of-way use lereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for CLow,I ate City and to replace pub prope' \damaged thers y. <br /> FINAL If4SPECTION Dale <br /> Approved as Constructed Si a AUTHORIZED <br /> t Date <br /> WORK AED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT 1io0 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 /> everett <br /> Phone. 259.8815 PROJECT OVER 90 DAYS DURATION. —�� <br />