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C M <br />9 H Vr <br />H 0 <br />f4 C) <br />z <br />�VJH <br />0� <br />OH <br />�tog)g <br />CJ• c� <br />C' <br />H <br />H <br />y H <br />g t=l CA <br />ZHrn <br />H O rn <br />C'i <br />MW <br />co <br />Date�_/z`�a <br />PUBLIC WORKS P90ff'" <br />Print or Type Only F <br />Owner City <br />Applicant Mailing <br />Pubi c W..tt Pe.mit .. <br />aka post • ._,. —. <br />❑able Wen, Fee — --- <br />1MAIF.•. <br />Let. ArMl Fee PAW <br />pa.Pr. pve 5.�G2_a_� <br />4,238 2-922- ele <br />orinn�r.�,'. 3vs-93 - ono -// 83 <br />/ <br />jjk�4 %fZip,?,0L Phone <br />! - I q5 <br />zip Phone <br />Describe Proposed Work 41- G _ " /4�__ <br />Project Address fit known) S� �'^' <br />`y -�+= <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />• Centerline of street <br />• Indicate North <br />proposed structures on the lot <br />• Show any oroposed grading changes <br />• Exishng and proposed utilities <br />• Show mer.suremenis <br />L <br />PERMITCONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />0. Cell Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />�o. �GiUocYr <br />To afE deWE f fCA.fls A�'P.�ovE� <br />Pe,,due u,1nee:; 1Jc�i od t9 r�IdDITIO ��:v� <br />AC N EDO w ENT F C NS <br />Approved as Constructed <br />everett PUBLICWORKS DEPARTMENT <br />3200 Ceder Street <br />Everett WA 98201 <br />Phone: 259.8810 <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 />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 />City and to replace public property damaged thereby. <br />7'A� <br />Siii aturearf6plicant Z Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />