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C:) <br />rl <br />1 r <br />Q.3 <br />!li <br />Date2_ <br />AlPhr. �lun 1 0l <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describn Proposed Work ��� SSQ <br />Project Address (if known) <br />TO POSTING 10 <br />City 'ip <br />Attach four (4) copies of plans for 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 />• Existing and proposed utilities • Show measurements <br />87•/e/ <br />Public l 9 Pe1mnp� � <br />Bldg DePI • _QJ y <br />Publk WPMs Fes <br />70181 Fee s <br />Lou APPI Fes Paid <br />Balance Duv <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for Inspection shell be made 24 his. in advance - phone 259.8815. <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 Service 48 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />9�a/�s�✓r TO �C'E.'oc9rE C�✓9 z0 ,�?AFL 9vPc�X . 2�t <br />fls SAer,a✓ oo Penr 1'e9A✓. <br />pproved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 982018201 <br />Phone: 259.8815 <br />UJ <br />Fm <br />0 <br />im <br />0 <br />n <br />Cl^- <br />M <br />0 <br />CL <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Imm any and all claims for damages, costs, <br />expenses. or causes of action that may arise because of Installation <br />and in tenanca of the improv ent or other right-of-way use hereto <br />applle for end further agrees to rlemove same upon notice from the <br />City a to r le a per Ic pro rty damaged thereby. <br />J� <br />.. It/\ 'A-Fj - <br />ignalure of Applident 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 />