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` 8f'/�D/Date b' / �er J Public works Permit* <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ v� <br /> Balance Due $ ''''7' .©c ) <br /> Print or Type Only <br /> je¢c e %` 775�7 <br /> i o <br /> Owner Mailing Address City Zip Phone <br /> .S' A.f,d1r49 t/C 3' C/rilvr .26O 7 r /.6)- 4'e E' e-Rr 7,4 26'20/ 02,1"6'- 28U0 <br /> Applicant Mailing Address City Zip Phone <br /> i <br /> Describe Proposed Work {{ C 4.1 h �p..b�t iC 4 c kir 4 57dil '{'RON / ea/Ay <br /> Re .4✓i/e' 5 /6Re (ie2/y/ .1 he, -k <br /> See a /74a c 42 d° , t-c4 b-1/rJ g <br /> W <br /> Project Address(if known) cam(6 0 ? Co/6.,,v A/ Immil <br /> Attach four(4) copies of plans for proposed work—Draw to scale and note the following as applicable: Nom <br /> • Property Lines • Centerline of street CO <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 c <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 259-8815. a <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 /> `-- -Vc4c 34\ 0u.. '= � `'C - " <br /> "' -\-�-= -0 `1...J\ 0 <br /> `` ' Cat- � l - -t <br /> • <br /> O <br /> CO <br /> On <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, casts, <br /> expenses, or causes of action that may arise because of installation <br /> } � and maintenance of the improvement or other right-of-way use hereto <br /> t applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> ell <br /> FINAL INSPECTION Date /.� <br /> Approved as Constructed Si ture o Applicant ate <br /> [evere) PUBLIC WORKS DEPARTMENTe <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 `DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BEPROJECT DILIGENTLYOVER PURSUED <br /> 90DAYSDU TORATION.COMPLETION. THIS PERMIT MAY Phone:259 8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />