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lAe7� <br />O�x <br />H I0•I <br />O CCO <br />it .y M7 <br />Cl) FN <br />Mz <br />H t7 <br />O H <br />Y' <br />yy H <br />t"yx <br />H H <br />ACV. <br />�M <br />13 0 (A <br />I Lil <br />WmxePermO.T7 <br />Brae. D.D1. <br />81". <br />PUBLIC <br />WORKS <br />PERMIT <br />°°°°ToeFee"' <br />Letx eppl Fee P°e S �.../— <br />s /S �/ J•—, <br />n <br />6eunce ous <br />Print or Type Only <br />f, <br />r J ae M <br />C <br />Owner <br />Mailing Address <br />RRY <br />O d <br />21p Phone <br />Address Lily <br />Describe Proposed Work /J.�1=— A <br />Prone <br />W <br />— r <br />Project Address of known) �^�� ✓)�l <br />Iseles <br />Attach four (4) copies of plans for proposed work - Drew to scab and note the foil- as applicable: �a <br />• Property Lines • Center... of street <br />• Outlines and dimensions of all existing and • Show to ogratlin North <br />proposed Structures on the lot y proposed g cnenges <br />• Existing and proposed utilities • Show measurements co <br />PERMIT CO <br />DO NOT WRITE BELOW THIS LINE 0 <br />N9 <br />1. All calls forr Inspe Inspection shell be made 24 lira. In ativance •phone 259.8810. <br />2. All work shall be performed in accordance with this Permit end current City of Everett Design and Construcvcn <br />Standards and Specifications <br />3. Cell Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1.800.424.5555. z <br />a <br />Approved lot ConstructWh Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />IWA11PUBLIC WORKS DEPARTMENT <br />17 3200 Cedar Street <br />EveretL WA 98201 <br />Phone:28&9810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applldant hereby agrees to hold and save harm• <br />less the City of Everett from any and ail claims for damages costs <br />expenses or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other nght•of•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace puhbc property damaged thereby. <br />Signature of APPilcant Date <br />WORK TIN <br />180 DAYS OFIZED BY THIS E <br />DATE PERMIT IS ISSUED AND THEREAFTER ISRMIT 1AUST BE STARTED H!0 <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 />a <br />