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O to <br />7 AMW <br />Date -' z-1 • J 1 �'' . <br />^I POk Wade Pompa <br />Application For Bdo Dept • _�11 •' B(°(•'1 <br />PUBLIC WORKS PERMIT <br />Print or Type O•Jy <br />TO POSTING!'�Z <br />Ppbk Work, Fee <br />tole) Fee S <br />Let, eppl Fee Poe $ _ <br />BeleMe Due <br />'Ili \\/L_LC. �_. LvL I. , L. k- (2—`t , ILeu L. pcetiv0.� Lynn �4:L \Va JCC-37 �•Lcu1 <br />Owner Mailing Address City Zip Phone <br />Applicant Melling Address City Zip Phone <br />'Ina Iz {•Jnl. <br />Describe Proposed Work NLw — � 1,) 1- <br />Project Address lit known) <br />Attach lour (4) copins of plans for proposed 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 />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 94 hrs. in advance • phone 259.8810. <br />2. All work shall be performed In accortence with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 fire. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />cT <br />Approv 'Tbr Cornllruction A Date <br />FINAL INSPECTTO 4 Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />320 <br />19L 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 269-8810 <br />`W <br />I <br />_/ <br />M <br />O <br />n <br />21 <br />C <br />Cl) <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less 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 righl•ol•way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public properly damaged thereby. <br />� Igneture of Applicant Date <br />WORK AUTHORIZED BY TI4IS 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 BY THE CITY UPON ANY STOPPAGE OF WORK ON THI:; <br />PROJECT OVER 90 DAYS DURATION. <br />