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H30 <br />A�tx <br />C Fr <br />�Hcn <br />HE4 <br />K H 0 <br />MO� <br />II--�II <br />zH <br />H H <br />gy <br />17CC4 <br />H En <br />HOvn <br />C31 <br />"ess, a—i <br />DateJOi TO POSTING I' L119/ <br />A nplirah on Fnr <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� . E Nt1tsrW '7V1- <br />Owner Mailing Address City <br />Pubes WOM PeQ1m�11 •�� r�/ppO —(.//'Q <br />Pu4he Woo, fee <br />Tow ha -.— <br />Lan apol Fee Pa-d 6 <br />ealanca Due i � G� <br />/O,?40 <br />,74. ,y 4 :,mews / A /19G 1,71leteezz 64c 1^81oG 3sz71 bitY <br />Applicant Mailing Address City Zip Phone <br />�' j <br />Protect Address lit known) etl—e4tlT — <br />Attach lour (4) copies of plans lot 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 <br />proposed structures on the lot • Show any proposed grading changes <br />• Exlstl Tg and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 lira. In advance - phone 259.8810. <br />2. All work shall be performed In accordance with this permit and current Cgy of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />`� ldv2 .4J 49e, d0-j, � /0"'2..' p&( <br />all40_x <br />Approyv �for Construction p ate <br />FINAL INSPECT__ �DIF, <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201820t <br />Phone: 26e-BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />0 <br />M <br />W <br />n <br />0,11h <br />d <br />The undersigned owneriapplicent 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 ofiblic property, damaged thereby. <br />zzQ AzlC,_ <br />SIpfiture of Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />80 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 />