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�N <br />yyrn <br />y � <br />L< O <br />KI H rL }j}j <br />N H Date: 0 _,� q {} 0-do wr-.. vermn . O rC <br />Hx i0 DUSTING '� =I 9 9np D.pi• <br />Op � AnnlicatWn For — <br />rr��Hry-� PUBLIC WORKS PERMIT Pueit Won.Fe. <br />Iti I�rl V ter.i Fe. s --- <br />n Lea. Moi Foe pea • <br />ya.a.r.D.. <br />y Print or Type Only $ <br />H H r) A to <br />!n <br />r.. ` Owner MaQih I�s City Zip Phone <br />o u, ; C�iNf C1PErNCa2 $ vt$ <br />Applicant Mailing Address City Zip Phone <br />Proposed Work <br />W <br />Project Address III known) sc.,/S <br />Attach four 141 copies of plans for proposed work • Draw to scaly and note the following as applicable: <br />• Property Lines • Cenlerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />'Cl • Existing <br />_, and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />11 PERMIT CONDITIONS <br />.� vi 7 1. All calls for Inspection shall be made 24 hrs. in advance • phone 259.8810. <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 ServlC048 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. Z <br />saw <br />_J <br />2 9- <br />Approved�onstruc on Date <br />FlIMILTWSPECTION r Date <br />Approved as Constructed <br />n <br />PUBLIC WORKS DEPARTMENT <br />eCedar Street <br />Everett. <br />ett. WA 99201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hnrm- <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 rlght•ol•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 />e,�L l�il/AIr Zta, -7._2 f'- <br />Signature Applicant / / (/ ' Date <br />WORN AU HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />190 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 />