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Bldg Dept <br /> A[`Pbcab on For <br /> PUBLIC WORKS PERMIT Pub <br /> To lFeeF~ <br /> Lnu April.Fee Paid fill <br /> Balance Due <br /> Print or Typo Only �f� <br /> Fl.asre,.u' L , vs,- .23S- mcox 79-r-y ?y, <br /> Owner Meiling Address <br /> City Zip Phone <br /> 5'9'' rCity ZAP Phone <br /> Meiling Address <br /> Applicant zp <br /> H <br /> �i 'l1L C... <br /> Describe Proposed Work - n <br /> m <br /> 90 r -i <br /> LU •r y <br /> rn m <br /> Protect Address lir known) Cl <br /> rT n <br /> ��Y <br /> Attach four(41 copies of plans for proposed work• Drew to scale and nota the following as applicable: � G 3 <br /> • Centerline ,f street <br /> • Property Lines 1.1 <br /> • Indicate North a' <br /> • Ouli,ne and dimensions of all existing and • Show any proposed g•oding changes r=•r <br /> proposed structures on the lot • Show measurements , z <br /> • Existing and proposed utilities ��rll Y -i <br /> DO NOT WRITE BELOW THIS LINE r— _ <br /> •"f rn <br /> PERMIT CONDITIONS CD 2-phone <br /> 1. All ccl,s for Inspection shall be made 24 trite, in advance•phone 259-8815. <br /> ■ <br /> 2. All work shall be performed In accordance with this Per and current City of Evnrell Design and Construction ■I -4 <br /> Standards and Specifications. _ <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1.803 424.5555. rte! rin <br /> L <br /> 0 <br /> CD r- <br /> z n <br /> —I r <br /> m <br /> n <br /> Cl) - <br /> n <br /> 0 <br /> �e V <br /> z <br /> C <br /> .-1 <br /> M <br /> fn <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 /> ilnd maintenance of •.he Improvement or other right-of-way use hereto <br /> �,� t-�•- '�S applied for and further agrees to remove same upon notice Tom the <br /> Approved for Cons ucti ata City and to replace public property property da�mag`ed thereby. <br /> • y/ Date C= CifVi 1 1 <br /> FINAL INSPECT57 <br /> I SiI Ill of Applicant Date <br /> Approved as ConstructedWORK AUTHORIZED BY THI:, PERMIT MUST BE STARTED WITHIN <br /> Pvr•rrtt PUBLIC NORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Carter Street SE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 2598815 PROJECT OVER 90 DAYS DURATION, <br />