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r <br /> ate_( c Puck Works Permx e/ d �( <br /> 1PP arahnn f or <br /> Zip Dspr a l'� <br /> PUBLIC WORKS PERMIT PuplC Works <br /> Total Fee Fee <br /> $ <br /> Leu spot Fee Pski • <br /> asllMa Dae • 12 + <br /> Print or Type Only — <br /> riene j� lsO-74, 440 -St NE 31dn©-Ai?e�r+�or�A (1905W. sas—-ISS 1 <br /> Owner Mailing Addrass Citvj Zip Phone <br /> I �l <br /> Applicant Melling Address City .LZip Phone <br /> Describe Proposed Work n/1Yl lrlf✓� (1 �YYYlrmea_ L�[. n �,A/ Eyety tAillp _ <br /> Project Address lit known) 727 17 0,45" y�,L ` k1' - <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: r— <br /> • Property Lines • Centerline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate North CI <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> 00 NOT WRITE BELOW THIS LINE W0 <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259.8810. <br /> 2.All work shall be performed In accordance with this permit and current City of Evere-t 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 /> 0 <br /> r <br /> Fass <br /> 0 <br /> 0 <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 for damages, costa <br /> expenses, or causes of action that may arise because of installation <br /> �.` and maintenance of the improvement or other rigni-ol•way use hereto <br /> applied to, and further agrees to remove same upon notice from the <br /> Approved for r C <br /> nstn Data City And IL replace puhli 0 rty damaged thereby. <br /> '14 <br /> FINAL�JSP TION ' Dale ature o ppli <br /> Approved as Constructed ncant De <br /> everrtt PUBLIC WORKS DEPARTMENT 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 /> i <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />