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;: s r y.. <br /> Date Public Works Permit# <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due $ <br /> .BO(Hr A/EL5bAJ /1// c _, 1/ A'J1 7' l 9Z b> 590207 <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work bed/4007-5?x JA./ /ate'. /,/ -7-0, e- /0'6-k <br /> 2, %0 4/90 3/5/9 0 <br /> W <br /> Project Address(if known) 1.111.1 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CIO <br /> DO,NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <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 /> r t o c._4( <br /> (_ r-,1- (_, yL.- ,t-''t-.�`E✓..P'' ,-e" �i �. ,, �r�, ',,2. --v� c 0 j '6`- ~(-°> -e, <br /> 0 <br /> p ,v,,i,4-.' ifv_ela —6_.,,t,,,u, .3 s---- 9 0 imin <br /> CO <br /> 0 <br /> a <br /> IIIMMINMIIIIMMI <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 /> f 7expenses, or causes of action that may arise because of installation <br /> iyj /J ��` L/� and maintenance of the improvement or other right-of-way use hereto <br /> � fp / applied for and further agrees to remove same upon notice from the <br /> Approved for Cos ruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date /j4 7k-Aell's— a�-1a?4.6, <br /> Approved as Constructed Slgnatu /Z of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WOR AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> telEverett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> \ / PROJECT OVER 90 DAYS DURATION. <br />