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Date f <br />Application For <br />PUBLIC WORKS PERMIT <br />TO POSTING C'2`15` <br />Print or Type Only <br />9a6— F7�=eft sF ar <br />t r"ILE GLi City <br />� Melling Address <br />Owner 1� <br />98 <br />fib City <br />Mailing Address <br />Applicant J <br />Describe Proposed Work <br />LcoS <br />Pubus works Permu• `� i <br />Bldg Bear • %1 /._. <br />PubLC Works Fee S -�- <br />Tolsl Fee <br />Less sPPI Fee Pent S <br />13811 Bue s <br />LO 1 7V - 2 rr <br />Project Address (if known) _ licable: <br />lens for proposed work • Draw to scale and note t Ce Ile wino of slowing <br />Veel <br />Attach four (41 copies of P 0 Indicate North <br />• Property Lines grading changes <br />• Outline and dimensions of all existing and Show any proposed <br />proposed structures on the lot <br />• Show measurements <br />• Existing and proposed utilities <br />'X-9O°Y <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance • phone 259.881 <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 />3. Cell Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1.800.4i4,5e5 4i <br />APPf' .+ Sb.�.11 f,9rc.tQc wa�cr agP.�l gsewer <br />r 0 vN LA 9" r C U4• <br />30l ti� �cwQ- y� 1 ` �esL �—Co-90 <br />Date <br />approved r onstru ion <br />FI AL .SFr=GTI <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />PvereU 3200 Cedar Street <br />Everett,WA <br />Uale <br />Phone: 25959•OBIOBB10 <br />W <br />H <br />Cl)NNW <br />ca <br />O <br />z <br />O <br />■ <br />Cl) <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONSand save harm - <br />The undersigned owner/applicant hereby agrees <br />arise beCBUse of installation <br />less the City of Everett from any and all claims for damages, cos s, <br />expenses. or causes of action that may use hereto <br />and maintenance of the Imroveomeemove or tsame upher on notice from the <br />applied for and further agrees <br />City and to replace public property damaged thereby. <br />P'l%lla Tdf� polo <br />6'2 U <br />Signature of APPllcent <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS II ED AND THEREAFTER IS TO <br />ETION <br />BE DILIGENTLY PURSUED TO COMPLCANCELLED BY THE CITY . THIS PERMIT MAY BE <br />ONANY <br />STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />