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A:r�x <br />9 1 f3 cn <br />KH� <br />�m0 <br />N H <br />OH <br />tig <br />9H� <br />t 1-r H <br />8°'H <br />Ca t7 to [ <br />I R y <br />H U m <br />Cz <br />t I <br />c7l, <br />mug <br />' Yk <br />�,.I d <br />Date_ 5z;2 .FS <br />Appliu0�0, ,u <br />/F — <br />PUBLIC WORK 3 PERMIT <br />TO PCSTIN <br />Print or Type Only <br />�Applicant Meiling Address <br />Describe Proposed Work <br />Protect Address (If known) <br />Nbbc Wmk. P,,,mn . _ 6 " _1 <br />57 <br />Btdd. Dept. <br />' PleurM¢Wo,k. FN <br />iaul He <br />I APPLra Pud4 Dua If <br />sIf -_---�. <br />��— <br />Zip <br />Attach four (41 copies of plans for proposed work • Draw to scale and note the Iollov'ing as applicable: <br />i Property Lines • Centerline of street <br />• Outline and cilmenslons of all existing and sr Indicate North <br />proposed structures on the lot • Show any proposed grading :hanged <br />• Existing and proposed utllit;es • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hra In advance • phone 259.8815. <br />2. Ali work shall be performed In accordcnce with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />evewit 1 PUBLIC WORKS DEPARTMENT <br />EverCedar Street <br />Everett. WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMEt, i OF CONDITIONS <br />z <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm, <br />less the City of Evorelt from uny and all clelmq for damage% costs, <br />ezpen a or eauaea of action 11M may arise because of hslallatlon <br />and a tenarice of the improvemhnt or other right-of-way use hn'eto <br />app and �4rther ngrees it jtreove same upon notice from the <br />City nd o rep(aT ppblip properjy damaged thereby. <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 THin <br />PROJECT OVER 90 DAYS DURATION. <br />