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`� • , OII�IL <br /> ' G 'w� � Cudm WorF•Pmmil <br /> DateY�fLY ye /dyyY3 <br /> 900 D.PI <br /> A pphn Udn fm <br /> PUBLIC WORKS PERMIT Nb <br /> elalxl Feer"' • <br /> H n " <br /> � lnx AMI iee nurl <br /> 8elence Due S <br /> [ H Print or Type Only <br /> 9 yfn <br /> " 73< <br /> K c" /h n o r t) Li/ 0"A,10 614 d-U 5/ f� /! SE rciT 9d Lo Y Phone �3 S 2 <br /> H M Owner Malting Address City ZIP <br /> 'i1 " IV <br /> CA "" <br /> x Z 3 Applicant Mailing Address City Zip Phone <br /> C) O IlTT�11 <br /> H08 Describe Proposed Work <br /> 0 v n <br /> yzyz <br /> y YaBri <br /> to <br /> O 0 [n Protect Address PI known)) •� � y � 2L- <br /> 2 t- Attach four(4)copies of plans for proposed work•Draw to scale and note the following as applicable. <br /> H HIn • Property Linea • Centerline of street '^ <br /> o <br /> •Outline and dimensions of all existing and • Indicate North �1/ <br /> Proposed structures the lot • Show any proposed grading changes <br /> • Existing and proposed <br /> ulililles • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE O <br /> i <br /> PERMIT CONDITIONS <br /> sal <br /> C <br /> 1.All calls for inspection shall be made 24 hra In advance•phone 259.8810, <br /> `J 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construrhnn <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. Z <br /> Ink an, 0 <br /> Fbzl11-r NOT KQLUIGED <br /> ru F 'JL Mom- F- <br /> CnE <br /> 1a. ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownerlappllcant 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 righl•of•way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale Date <br /> Approved at Constructed Signature of Applicant <br /> WORK 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 /> W <br /> Phone:2598810 PROJECT OVER 90 DAYS DURATION. <br />