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D8te'7XV-1-21-1 r 14`0� I Pub ie Works Pelmll• !��--- <br /> Application For "les.Dmt.a ra. — <br /> PUBLIC WORKS PERMIT Publico:orks <br /> FeeFea <br /> Less APPt Fee Pale 5 - <br /> Balance Due <br /> Print or Type Only <br /> hffl 'lir jkgM(n q0 blS�" St_��anaff LU>< <br /> Owner Melling Address City Zip Phonr <br /> rn &AyC 2L,—A1280y 9L9 n4S41111C° u In 96 a7D 4`63-DO5S <br /> Applicant �1/�(' Malling Address CI Zip Phone <br /> /,{ <br /> Describe Proposed Work ' ddifi m <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 /> • Properly Lines • Centerline of street /A <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 calla for Inspection shall be made 24 hire. In advance• phone 259.8815. �t11 <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 /> p O��3uG �vvees �r>�is��i' �ah,T'.PFgu.e,�p LL <br /> r <br /> f 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 for damages, costa, <br /> expenses, or causes of action that may arise because of Installation <br /> and maintenance of the Improvement or other right-of-way use hereto <br /> applied for and further agrees to rdemove sam upon notice from the <br /> Approved for Construction Dale City and to replace public prro`pertt`y da aped t reb ._- <br /> —_' 1I \, Vim/ <br /> FINAL INSPECTION Date Dale <br /> Approved as Constructed ignature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT <br /> Pvemtt 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 /> Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. <br />