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_�,L � <br />Date <br />Application or <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />o �e�`K�� . <br />/1 _ 1,-.,�-�7 �.., -, G�.l <br />Applicant <br />Describe Proposed Work <br />Address <br />Mailin9 Address <br />City <br />cny <br />Proled Address (if known� — - — � <br />Attach lour (4) copies of plans lor proposed work - Draw lo scale and note the following as applicable: <br />• Properiy Lines <br />• Outline and dimensions of all existing and <br />proposed siruCtures on ihe lot <br />• Ezisling and proposed ulilities <br />1`l�blic \VOIFS Pel flll � � <br />L <br />omA oen� + <br />Pu�Lc 1Porb Fee S <br />Total Fec <br />LCss AODI. Fee Pdid $ <br />PdldnU• Our � <br />• Centerline ol street <br />• Indicale Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />rnone <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 peAormed in accordance wilh this permit and current City of Everett Design and Consiruction <br />Standards and Spe:ifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />f�.�c��c�C�cz���^.�u����`` ,�,��-r��l� <br />:��� �,.�.� <br />�-�o -�v <br />Approved for Construction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGGMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />N <br />� <br />a <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />Iess the City of Everett Irom any and all claims for damages. costs, <br />ezpenses, or causes of aclion Iha� may arise because ol installation <br />and main�enance of the improvement or olher nght-ol�way ��se hereio <br />applied lor and lurther agrees to remove same upon notice irom the <br />Gity and to replace public properry damaged thereby. <br />Si�nature ol Applicanl Gate <br />WORK AUTHORIZED 0Y THIS PERMIT MUST 8E STAFiTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIO`I. <br />