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Date 1-x A Y <br />Application Fn• <br />PUBLIC, WORKS PERMIT <br />Print or Type Only <br />C0,0Z. 9spgz -i9 <br />Owner Mailing Addresi <br />, t^ <br />ppllcant Meiling Address <br />Describe Proposed Work `v 0-Lr% <br />Zip <br />No., Wo.kk Pe e 8y Bldg -- <br />Deer <br />Public Works Fee <br />Tots <br />Lau APPt Fee Peed le <br />BeUnce Due >< <br />YQ • CJ (i <br />Protect Address (it known) „ Mt v � 6, <br />a{{' <br />Attach four (4) copies of plans for proposed work -Draw to scale and note the loltowing a epp9cab <br />• Property Lines • Centerline of s el <br />• Outline and dimensions of all existing and • Indicate North <br />pro?osec structures on the lot • Show any proposed grading changes <br />• Existing and propocod utilities • Show measurements - <br />�iy53 <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection, --hell be made 24 hire. In advance - phone 259.8815. <br />2. All work shall be pe: formed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Spdcificatlona <br />3. Cell Location Underground Service 48 hra before you dig TOLL FREE NUMBER 1.800-424.5555. <br />as Constructed <br />everett PUBLIC WORKS D <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNONLEDGEMENT OF CONDITIONS <br />Vf T_ <br />m <br />W <br />ma <br />losses <br />o� <br />iti�e <br />yy <br />0 <br />-z-t <br />m <br />ycz <br />r <br />< �T <br />C� <br />T <br />n <br />m. <br />N <br />gm <br />Z <br />C N <br />1 <br />3 <br />�m <br />M <br />Y <br />A <br />H <br />H <br />S <br />U <br />2 <br />H <br />S <br />` <br />N <br />IRMO, z <br />C Cl <br />H <br />C- <br />�s F•i <br />The undersigned owner'apolicanl hereby agrees to hold and save harm- <br />less the City of Everwi from any and all claims for damages, costs. <br />expennes, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use herein <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />sip isture of Applicant I - -­ <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1110 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 15 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 />