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H O tte <br />iw <br />7 <br />u <br />Date <br />Application For <br />Go <br />PU13LIC WORKS PERMIT <br />Q <br />Print or Type Only 88 <br />Future Work$ Pareld a / O 73 <br />Bldg. Door. a <br />Pubec Works Fee $ <br />Total Foe <br />Lass APPt Fee Paid $ ---�-- <br />Balance Due $ �� <br />E'v, wnf4 1FY.2/ %Sl-- y,>/ <br />rnone <br />Owner apt mauury nuwca� --• <br />N O W <br />7-1 <br />Applicant <br />Mailing Address City Zip Phone <br />Describe Proposed Work .�MD �rid�C �� �I�GcJ /�N� CD✓s�iE- _. <br />Ll/iTf/ D/.eT {Pr>/ri GLruc�ti.✓lr O,� �i9N SEit/ .�.eo,�E,eTV <br />WL <br />yc. <br />Project Address (it known) ' <br />Attach four (4) copies of plans br proposed work - Draw to scale and note the following as applicable: <br />r_ <br />• Property Lines • Cenlerline of streetCAI <br />• Outline and dimensions of all existing and •Indicate North <br />proposed structures on the lot •Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements /H <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424-5555. (z <br />C. <br />7XiLG��iO:, Z/ <br />Approved for tonstruction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ec-i•rett PUBLIC WORKS DEPARTMENT <br />treet <br />Ever Cedar 8201 <br />Everett, WA 98201 <br />Phone: 259-8810 <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 at other tight-ol-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 />160 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 THIS <br />PROJECT OVER 90 DAYS DURATION. <br />