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Appbr,M*n F or <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200, Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />TYPE OR PRINT ONLY <br />Date <br />Public Works Permit 0 9 9� 2Sa <br />Building Permit 11 <br />Public Works Fee $ _ .20 <br />el- <br />CIEW-1 S I� V S ti &. S' `t'�-a ��✓R'� � /En�rTT °I`'Zy3 2SZ—000� <br />Owner Mailing Address City Zip Phone <br />Annbr.nt Mailing Address City Lip Phone <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) S 0/ r <br />Attach four (4) copies plans for proposed work - Draw to scale and note the following if applicable: <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities <br />• Centedine of street • !odicate North • Show any proposed grading ch-nges • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONI'DITIONS• <br />1. All calls fv, insoection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and current City of Everett Des±gn and <br />Construction Standards and Specifications. <br />3 Call Location Underground Service 48 hrs. before you dig. TOLL FREE_ NUMBER 1-800-424-5555. <br />4, fl2C�I Gt// Strcdj <br />`t, Qvl(y r4oC11�'0r-L1 <br />reiulre a�dl�iona� <br />C Le4 h 4T 41t - / mes <br />Gvork an 4AIs- Sl�c [Ajf << <br />Par -M f t$ <br />ApprooLo vor one ruc ion Vale <br />FINAL INSPECTION Date <br />,Approved as Constructed <br />z <br />0 <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everutl from any and all claims for damages. costs, expenses, or <br />causes of active that may arise because of installation and maintenance of the <br />improvement or dhat rr'i',ght-of•way use hereto applied for and further agrees to <br />ac� ur ce frgFF1 the City and to replace public property dam - <br />a <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 190 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPI Er10N. THIS PERMIT MAYBE CANCELED BY THE CITY UPON ANY STOPPAGE OF WOR (ON THIS PRO,ECT OVER 90 DAYS DURATION. <br />