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31 <br /> if Date Public Works Permit# <br /> Application For Bldg.Dept.# � il <br /> PUBLIC WORKS PERMIT <br /> Public works Fee $ /4'�2,>g <br /> Toial Fee I") � <br /> Less Appl.Fee Paid $ -7 7 4 <br /> Print or T e �n� Balance Due $ `'7`5ZZ / <br /> yp Y I <br /> -q_ 1 BELLE l 1 ..E Ssc `i •. tit/ <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address, City Zip Phone <br /> Describe Proposed Work K\E /\\\/ <br /> / <br /> W <br /> Project Address(if known) <br /> /S/0 -- / E, .5""/ /o (15.9VC/':e. .) • <br /> Attach four(d codes of plans for,proposed.work Draw to`scale an not the following as applicable: <br /> • f�opertyLines • Centerline of street <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 <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS x , <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 FA <br /> + .. Standards acid Specifications. <br /> 3.CaII,Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> 42 . <br /> ,/__ 20 --P 9 <br /> t„F„. , <br /> ,74,7 /1, 6 , Cn <br /> ;7 0 <br /> , ,, , //D.) <br /> /"" ACKNOWLEDGEMENT OF CONDITIONS <br /> `-' The undersigned owner/applicant hereby agrees to hold and save - <br /> ,r� t. less the City of Everett from any and all claims for damages, costs;'' <br /> T --- - — expenses, or causes of action that may arise because of installation <br /> c . ': and maintenance of the improvement or other Tight-of-way use hereto <br /> y <br /> 'istr ion 'II <br /> Da e applied for and further agrees to remove same upon notice from the <br /> ved for <br /> City and to replace public property damaged thereby.- <br /> /fir <br /> FINAL INSPECTION Date "' -/e <br /> Approved as Constructed Signature of pplicant Date <br /> 1 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS T <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B' <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON T�;' <br /> t,\ ` J Phone:259-8810 PROJECT OVER 90 DAYS DURATION. i I <br />