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Data `' PuELc Works P•rmll <br /> Application For 8100 Deer• <br /> PUBLIC WORKS PERMIT P.blm Wlr *F•• <br /> TWO Fa• t <br /> Lou AMI Fn Pad { <br /> Balame Du• <br /> P((Printor Type Only eabp-ri IE / J I ?/ j 7 T r t <br /> Owner Mailing Address City Zip Phone <br /> loLIlTet� r Le�T � �t4-��'�'Pl. S.lv, ELr�rett 9&)c3 35-3- <br /> Applicant ff Melling Address CityZipPhone <br /> Describe Proposed Work (I r4e n- �v X Zf L RB e) n1 I"ff' Q D l- Vr�,1 i Cl P m n in 14 <br /> , <br /> Prclect Address(it known) 2L"(1- A]/A Th P/. .S. -� -�- W <br /> Attach four(4)copies of plans for proposed work•Draw to scale and note the following as applicable: to <br /> • Property Lines 0 Centerline of street /A <br /> • Outline and dimens;ons of all existing and • Indicate North V, <br /> proposed structures on the lot • Show any proposed grading changes <br /> 0 Existing and proposed utilities 0 Show measurements <br /> Im <br /> 00 NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1. All calls for inspection shAll be made 24 hrs in advance• phone 259-8815. <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. Call Location Underground Service 48 his, before you dig.TOLL FREE NUMBER 1-800-424.5555. <br /> d (/Lt <br /> o 16( C y <br /> 3 L) 4 En <br /> ACKNOWI FDGEMENT 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 f. <br /> expenses, or causes of action that may arise because of installation Lr. <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the t, <br /> Approved for Construction -D a- City and to replace public property damaged [hereby. f <br /> rl <br /> r" <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date k <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN t <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. T141S PERMIT MAY BE i <br /> le Everett. WA 98201 <br /> Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS I <br /> PROJECT OVER 90 DAYS DURATION. <br /> i <br /> f <br /> i <br />