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rd <br />1 <br />Oate'I— 1 _` 3 Public Works Permit a Sj47 <br />Applicat.on For Bldg. Dept a <br />PUBLIC WORKS PERMIT Public Works Fee <br />Total Fee s (0 2 • S l7 <br />L¢sa Fppt Fee Paid $ _ <br />balance Due s �n Z • 5 U <br />Print or Tyke Only <br />(111Ct1AeL UJA1_r1Zs R� STA U),:50) 98a9-:i as9 -S9' <br />Owner Mailing Address City Zip Phone <br />_ 'apmc <br />Apolicant Mailing Address 11 `` City Zip Phone <br />Describe Proposed Work CL�k, `=.-�r In. e-�- L i ix -A d v ts. c <br />n1"'. c .-- d�...-�re.- Stt.r pliril rG-Aed 4 IL 33 <br />W <br />Project Address (if known) 11,9Z4 CC5,—e <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 <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements wA <br />DO NOT WRITE BELOW THIS LINE WO <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. <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 481 -s. before you dig. TOLL FREE NUMBER 1-800.424.555.3. <br />,z -e r r-o A a.A a .Y A A L/1? <br />1ev,ku <br />al W�\N �V\NMI OF \Z �KC� 1«-�j-et\\e.x d y�..N ea.x Q%•13't-IN� <br />1 1 <br />r r at,V ,cl •�� OT <br />FINAL INSPECTION <br />INSPECTION ' t� <br />Approved as Constructed v <br />everett PUBLIC WORKS C <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8815 <br />t <br />i// /' r <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 />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 />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged t.`cireby. <br />Signature of Applicant \ Date <br />WORK AUTHORIZED BY THIS PERMIT UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED CY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION, <br />J <br />-11 <br />