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r - <br /> 1 <br /> >a <br /> r; <br /> f (rY. .. <br /> ,t y, l <br /> Date Bldg 3emw,re,mn <br /> 83 I► <br /> aipp pf.• / <br /> Arpl�cation For <br /> 09- <br /> PUBLIC WORKS PERMIT Puel.ilToleFeeFea tt �� <br /> Lau APPr Fee Peed <br /> BNence Due <br /> Print or Type Only <br /> A Xe- Ili koLqq <br /> Owner Melling Address City zip Phone <br /> /tz it <br /> se f1� <br /> Applicant Melling Address City 21p Phone <br /> Describe Proposed Work ilk ' Lel -- <br /> W <br /> Project Address(If known) 0 <br /> Attach four(4)copies of plans for proposed work.Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of:,treat <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cells for Inspection shell be made 24 hrs In advance- phone 259-8815. <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 hrs.before you dig TOLL FREE NUMBER 1.800'424.5555.. <br /> 15011dfe A� pf,p..- ""! �,L USG (t K1b�'\�a dr.J(.✓Oy Q�NN f 1\ MfW ,/�) <br /> pfWewa '1! ft1.wuhQ �"Q �.t-Irl�a#1//+��w� //�LI � fP�avnJ O <br /> Per se�c,I%.- 311.3.7 P�' CAI of FUL•rte 41 3 ji-,Z.4 <br /> PFShbr. YfA,� ,-fe alovt� ~-.4 5 ;c4e (oI- /�/6P <br /> s6mil b( W,4, the IM�er,n.l3 ^,P w..a.�- i . r A-yir 'cJ' <br /> or,or eo�Orl..` • O <br /> I V a <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, costa <br /> expenses, or causes of action that may arise because of installation <br /> and malntenar :c •f the Improvement or other right-of-way use hereto <br /> appliaTTO no ther agrees to remove same upon notice from the <br /> pproved for Construction Date ty a to Fiat;•public property damaged thereby. <br /> SAL INSPECTION Data <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PE>MUSTARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS REAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO CERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON WORK ON THIS <br /> Phone:259.8615 PROJECT OVER 90 LAYS DURATION. <br /> J <br />