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i <br /> H <br /> O H <br /> 17 <br /> yHN <br /> H 0 <br /> HW <br /> Otto <br /> N Hr r mac Wb P <br /> i •imd <br /> Date 'J.",nDart�LSt 1 5� <br /> 'Zp <br /> H <br /> `N H S Application For <br /> OH PUBLIC WORKS PERMIT "'°'1.181 cw`w°'"Pe'`°' <br /> e <br /> CM" g Lew APPI Fee Paid f <br /> �w l7 s <br /> H B•�•ece eee <br /> y HPrint or Type Only <br /> H H <br /> O N H L� /1 �• ;l (' �ve�Prf• 9�f'�� z 35s-3.�i/9' <br /> C1 U En -72r !/� 100 7� r� •+C CItY Z p Phone <br /> [p � Owner Melling Address <br /> H N _ R �hL t 5fed(v �:/P l4�f <br /> HON f�JJ'' <br /> Applicant Melling Addressr City Zip Phone <br /> Describe Proposed Work - - ---_------" — <br /> Q —-- W <br /> Project Address III known) A 7A " Z" I r <br /> Attach lour(4)copies of plans for proposed work•Drew to Stale and nose the following as applicable: <br /> of <br /> s <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North y <br /> proposed structures on the lot • Show any proposed grading changes I <br /> • Existing and proposed utilities • Show measurements <br /> 'C� s <br /> � DO NOT WRITE BELOW THIS LINE O <br /> 1 PERMIT CONDITIONS 269.8810 <br /> � pp 1.All calls lot Inspection shall be made 24 lira.In advance•phone . <br /> 1 f 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br /> iS Standards and Specifications. <br /> 3.Cali Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800.424.5555. <br /> I I_. 0 <br /> tAFees <br /> eases ease, 44021`-� Cn <br /> 9� 0 <br /> _ _a LL <br /> li ( 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 thzt 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 remove same upon notice from the <br /> r <br /> Approved for Construction Date City and to replace public properly damaged thereby. <br /> FINAL INSPECTION Dale Date <br /> WORK <br /> Approved as Constructed SlORK A of Applicant AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <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.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> 4 <br /> Phone.2598810 PROJECT OVER 90 DAYS DURATION. <br />