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Date Q •mxpworxsPerm"e �6-arg— <br />Appllcnilon For d a nept. • 1� <br />PUBLIC: WORKS PEFOANT °,-1F" ' s <br />Lev Apot Foe Pad <br />Print or Type Only Fl•r•nce Due d� <br />Z&6d14 L IL �/� i!a gig[ (Ll_ �.6Gr rzi u/If 7'zl1 Phone <br />U—w•�rie'r- Mailing Address Cdy Zip Phone <br />J Applicant Malting 4ddr[ ; City Zip Phone <br />Describe Proposed Work_ t/� ��Sk�Y(1.�.. _'`r-•---- <br />Project Address (if known) 71 20 th PZ'S•E' <br />Attach four (4) copies of plans for proposed w.)rk - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street ♦A <br />• Outline and dimensions of all existing and • Indicate North v+ <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE O <br />PERMIT CONDITIONS <br />1. All -,Its for inspectrorshall be made 24 hre. in advance • phone 259.8815. <br />2. All ..ork shall be perinrmed in accordance with this pe..-ut and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Locr.ilon Undergruund Service 45 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. aJal� <br />fo; <br />7�. CU,Pry� GvrlF.e �- 5����✓q�,� i9.c'r' cINc4'.PO.tE.�/, A,af'L�CA.v7 O <br />Wiu ,dE ,C'FSPor�aGE' jr,� .2EP�At�ti[s f�&/f/ d9Mr�GE.O <br />C'v� AJ brJrit�e � Since cJ�9i,c� . <br />N <br />O <br />Q <br />�Approved for Construction Date <br />Q.J�- OL? � 1�► l+�z.. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />I <br />rett PUBLIC WORKS DEPARTMENT <br />Ever Ceder Street <br />Everett. WA 98201 <br />Phone: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm - <br />leas the City of Everett from any and all claims for damages. costs. <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant 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 RY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAPS DURATION. <br />