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Date�-�/( b'6`o`E,T��''9� <br />9-3-87 Application For <br />PUBLIC WORKS PERI�IIiIT <br />Print or Type Only <br />Su n � 3 E�n v Fs�rhCit�s <br />3508 <br />Mailing <br />DeSL�be Proposed <br />Project Address (it known) � �" � — <br />i` Q.�' 9`'B <br />Atlach iour (4) copies of Plans for proposed plork • Draw to scai2 and <br />s Property Lines <br />• Outline and dimensions of all exisling and <br />proposed structures on the lot <br />• Exisiing and proposed utilities <br />87-3'� <br />Pupl¢ 1Yorks Pe�rjmit r O <br />BIEB. DeOc r O7 �r�%7�V <br />PuGlicWorkaPee y, <br />Totel iee <br />Less ApPI. Fee Paltl S / � 7 <br />Balance Oue $ <br />Ciry ZiP Phone <br />the following as applicable: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading chan9es <br />• Show measuremenls <br />FERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hra in advance - phone 259•881 5. <br />2. Ai� work shall be pertormed in accordance with this permit and current City of Everett Design and Constructiun <br />Slendards snd Specifications. <br />3. Call Location Underground Service 48 h:s. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� ST�PEETIM��'Ct���7E•JT.I �O �G CO,t/Si.e!/GEU {��� <br />f%��.�'p✓�.J PLl�i.rl�i l�F,�TE� 9� 2/�fi7 <br />for <br />FINAL INSPEG7T�N <br />Approved as Constructed <br />evcrett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 90201 <br />Phoner 259•8815 <br />ACKPJOWLEUGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save hurm- <br />less the City of Everett frum any and all �laims for damages, costs, <br />expenses, or causes of action Ihat may arise because of installation <br />�$ � and maintenance of the improvement or other right•of-way use hereto <br />applied for and furt ac�rees to remove same upon notice from the <br />Date d to reolace p 6iic operty damaged thereby. <br />1 -CF� <br />Dete <br />YJORK AUTHORIZED BY THIi PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERM�i lu ISSUED AND TIIEREAFTER 13 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WCRK ON THIS <br />PROJECT OVER 90 DAYS DURATION. J <br />