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r~meq arwy <br /> , u <br /> I <br /> 17' <br /> � Z <br /> F3 E0 /1-3 <br /> 7 / <br /> Date —d_g�L32 7L <br /> Bldg bind <br /> Oxo <br /> PUBLIC WORKS PERMIT P°b"`W°" "° : <br /> x <br /> ` O leu•n°i r.n NO 6— --�— <br /> H CJ 9adnrn eun S ,�1C _ __ <br /> H tog Print or Type Only lJC12 - ?Z-yp-Me)-/7r5:/ <br /> n• n <br /> Z _ <br /> H ZPhone <br /> f+ H Owner <br /> Mell... Address CnY Zip <br /> H <br /> O bq V1 p 14't e -- <br /> h1 Mailing Address City Zip Phone <br /> Applicant <br /> F-3 Otaifi <br /> /�cJtlon bi Px/�q <br /> Describe Proposed Work JJ <br /> I <br /> LU <br /> Project Address lit known) ��� • 7 S* SF __ -. - ---- - <br /> Attach lour 141 copies of Plans for proposed work•Draw to scale and note the following as applicable: <br /> of <br /> • Centerline rt street <br /> • Property Lines • <br /> •Outline and dimensions of all existing and how a North <br /> • Show a <br /> proposed structures on the lot any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> _ DO NOT WRITE BELOW THIS LINE 0 <br /> I PERMIT CONDITIONS <br /> 1.All calls for Inspection shell be made 24 his.In advance•phone 259.8810. <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 bra.before you dig.TOLL FREE NUMBER 1.800.424.5555. alas) <br /> I� �) (.J�z Z'tz /� 7` x4x .te: .0% /�{', hen. 1?� natt <br /> lam <br /> Iw, _ / <br /> _.I 1 0 <br /> a <br /> I— <br /> I_1 <br /> ACKNOWLEDGEMENT OF CONDITIUNS <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 /> and maintenance of the improvement or other right-of-way use hereto <br /> applied lot and further agrees to remove same upon notice from the <br /> Approved for Consiluc Date City and to replace public property damaged thereby. <br /> i <br /> FINAL INSPECTION Date Date <br /> Approved as Constructed <br /> Ig r i Appll nl <br /> WORK AUTHO ED DY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF ATE PERMIT IS ISSUED AND THEREAFILR IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> le Phone:2598810 PROJECT OVER 90 DAYS DURATION. <br /> 1 <br />