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Date <br />I <br />ra <br />Application For <br />PUBLIC WORK, PERMIT <br />Print or Type Only <br />Mailing <br />Public Works Permd e �'" 74 <br />Bldg Drpl.e <br />Publw Works Fee 5 Tulsl Fee <br />tun April Fee Paid S <br />eslenca Due $ <br />Applicant Melling Address City ZIP Phone <br />Describe.',oposedWork-- <br />W <br />- -- <br />Project Andress lit known) /PyP- 7p LPG _ SE_. LoT <br />L = <br />Attach four (4) copies of plans for proposed work - Drew to scale and note the following as applicable: Coe- ay PL9c1F' <br />• Property Lines • Centerline of street <br />♦(� <br />W <br />• Outline and dimensions of all existing and 4 Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />- • Existing and proposed utilities • Show measurements <br />M <br />WO <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. <br />arse <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 hr& before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />z <br />7 is/DEr-✓AC.0 q CutBS Ave;, 41.r/B.-otfc/, <br />ffrlr .[igm,o2� Tb T.YE�9 Si7/,9ct .bi_ ii'E.'li9l'F� Bf/ Xe— fi/�r1'.1.�/T- <br />O <br />.T, TE �OOF-TOP O,t'q/Ni7C+E �'v� �//Bc/G O,egiNAGE SyS>En7, <br />Cl) <br />40�, f%y G(qp/r/ p Dt/ !oT Tv a' ZCWe- So AS iVOT To <br />.IMiY7G7- TAwE .%.M,POU,vO/yam LOTS /*J/T,✓ �iib,✓4/iQ7f'iE �rAr/OIG', <br />O <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sheet <br />Everett, WA 98201 <br />Phone:259.8815 <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, costs, <br />expenses, or causes of action that may arise because of Installation <br />end maintenance of the improvemert or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replacepublicproperty damaged thereby. <br />Slg^nture of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />