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i--1 `Z--Y,'j <br />Date zi 9L ' <br />Application rcr <br />PUBLIC WORKS PERMIT <br />TO POSTING -2 f-JR-s <br />Print or Type Only <br />PuCM1c Wgrh, Permit . ci Z S74 <br />Bldg Derr. Wo 3 <br />Porn Work, Fee <br />Tel el Fee t{ <br />L.,,,p.' Fee Pud >< <br />Billion, Dee 8 20 - <br />�_gQ�l►t L�t;\/. ING. "713 363-("500 <br />Owner Melling Addres- City Zip Phone <br />lone <br />l�LL LANG1)53r73'(ySCYi�S`':,._ <br />Arolicanl Mailing Address City Zip Phone <br />Describe Proposed Wo•k _ Ne:*w "() )S'E <br />Project Address lif known) <br />Attach four (4) copies of plans for pronosed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />oronosed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calla for Inspection shall be nude 24 his. In advance - phone 259w810. <br />2. All work shall be performed in ac.,ordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.-5555. <br />�}. INSTALL.- EUE M ACQ.Oss Dew6w" AND Rti5L1iT•0E- <br />\V^,( TO DtvEl1;T- S•MP-M NATer— I!?,UWjFF TO IlPQL`T A-r SGtiTt'1 <br />.S%oe of KlcI I-tT- OF-v✓il. <br />5, GONSUL:T -,Y ITi{ (A gLIL WIDIZKS INSMCZOI- P1410111!'TO SiR<r1NC-t <br />C-OtOSTRVC1100 (339-7'4'L*)- <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />a less the City of Everett from any and all claims for dama;tes, costs <br />expenses, or causes of action that may arise because of installation <br />C Z " 1 - yL and maintenance of the improv9ment or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />on Date I City and to ruplace public property damaged thereby. <br />FI L I P TION ate <br />Approved as Constructed Signal of App cant Date <br />PUBLIC WORKS DEPARTMENT WOPI THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />3200 Cedar Street 1E 1GE T DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everett, WA 88201 BE DI IGENTLY PURSUED TO :.OMPLETION THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone, 259.8810 PROJECT OVER 90 DAYS DURATION. <br />