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Ni <br />I <br />\ <br />PuEhc Mike Pelmlr <br />Date 1-__ _. <br />Bido 0001 a 9)/35498 <br />ApphLMI on For <br />x <br />roteli <br />PUBLIC WORKS PERMIT PM°c WOMrne S <br />NCam-' <br />� <br />LexDPl Poe Pad B <br />u Fe <br />Btlence Due 1<_ <br />,O <br />v, <br />Print or Type Only <br />H <br />H <br />y <br />TARRY ?!f,(:ALIT,EY PO BOX 987 <br />LF; STEVENS 9825A 355-2079 OR 3J4-lobo <br />LP Phono <br />O0 =i­i 0 <br />Owner Melling Adtlress <br />City <br />En 1-i <br />H z <br />O <br />HU <br />OWNER <br />Applicant Melling Address <br />City Zip Phone <br />Hpy <br />Ozo <br />4—PLID( <br />cH] � () <br />Describe Proposed Work <br />AzAH <br />t"Hy <br />W <br />V) <br />H <br />C1CO <br />P t+ <br />Project Address (if known) <br />W <br />yin <br />Attach four (4) copies of plans for proposed work - Draw to scale <br />_ <br />and note the following as applicable , <br />• Centerline of street <br />y 0 <br />• Property Linea <br />• Outline and dimensions of all existing and <br />•Indicate North <br />• Show any proposed grading changes <br />proposed structures on the lot <br />• Existing and proposed utilities <br />•Show meassuremurements <br />DO NOT WRITE BELOW THIS LINE <br />sees, <br />'.r. �1 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance- phone 259.8810. <br />with this permit and current City of Everett Design and Construe <br />! 2. All work shell be performed in accordance <br />Standards and Specifications. <br />3. Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />4YI07 Al <br />Fm <br />1� <br />�(I�1 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />from any and all claims for damages, costa <br />less the City of Everett <br />expenses. or causes Of action that may arise because of Installation <br />end maintenance of the improvement or other right-of-w8Y use horeto <br />to remove same upon notice from the <br />applied for and further agrees <br />Date City and to replace Public property damaged thereby. <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />Date Dale <br />Signalers of Applicant <br />WORN AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />AdF—>7 PUBLIC WORKS DEPARTMENT <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />3200 Cedar Street <br />BE DILIGENTLY <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Everett, WA 98201 <br />Phone. _59-8810 <br />PROJECT OVER 90 DAYS DURATION. <br />