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Date 7.j r. ,�(.�1 P°Ur¢Works Peered <br /> Apph,:aiion For <br /> Bldg eePI a _s97iaa-5 z0-_. <br /> PUBLIC WORKS PERMIT P°°,Ktaiat e: . — <br /> FFee s <br /> leu APPi Fee POP 1{ <br /> Print or Type Only naianceove s ZO=° <br /> ne ,dl1 k JF-At0 9d 2rz3 s53 "17 ?k <br /> Owner Mailing Address City Zip Phone <br /> 11 <br /> t t <br /> 'Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work Tng <br /> 4 <br /> f <br /> I <br /> W <br /> Protect Address 111 known) — <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street ♦^ <br /> • Outline and dimensions of all existing and • Indicate North v♦ <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utibhes • Show measurements <br /> F DO NOT WRITE BELOW THIS LINE <br /> F PERMIT CONDITIONS Q <br /> 1.All cells for Inspection shall be made 24 hrs.in advance•phone 259.8810. aar� <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> fStandards and Specifications. <br /> F 3.Call Location Underground Service 48 his,before you dig. <br /> �TOLL <br /> ,FREE NUMBER 1-800-424-5555. <br /> /1-O.,.rtp7tl., ri3CL •�y CLv/1.e� /JUG�p 7/ QinAel.Q : a&-e4 <br /> � <br /> ,3 3. J 2,.e4.�. dl l� 0 <br /> -*307. L <br /> /-2tcG��f'cmC�u>/�y ch <br /> .t✓c�jva;e�z /O'uD"�' Xe .fra�r's`y Gt'.b�. <br /> le 15 <br /> �0j <br /> 11/I'�11 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 /> L �j�r��? end 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 /> Approved fo�Construc/ion Date City and to replace public property damaged thereby. <br /> L INSPECTION Dale <br /> Approved as Constructed Signalure of AG ant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street BE DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.W259-8810A 98201 BE DILIGENTLY <br /> Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 92CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />