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Cate—QS(sL� <br />Application Fo� <br />PUIB�.IC VVUFt�(S PER11111T <br />Frint or Type Only <br />.� <br />—f oH�,er <br />� � <br />Applicant <br />ng <br />Mailin9 Address <br />Describe Proposed W�rk ���� <br />Prolect Address lif known) <br />Atrach tour (4) copies of plans lor proposed work - Draw to scal= <br />Y Properry Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />/ l P��.bOCWorkSPm <br />� � aina o�o�. • �,1---- <br />FubUcWorMSFce 5 <br />Tol�l Fce — <br />Less AppL Fee Pni� S <br />BalanceUuo `�+ <br />ity <br />Gily <br />the following as applicable: <br />• C<_nterline ol stree; <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />1. All calls tor inspeclicn shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current Cily oF Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underc�round Service 48 hrs. befora you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�����.,`� I��T ��QJ � fzc,Y> <br />{�cc�-Q, wt°c�-Q._ <br />c5 � Z�, � S�°( <br />��"...��1/.c� s.e�.�- ��� �-�"•"�- - <br />— D�� � c.�� -fo,� �1�. � � c.�o_�P ��-r` � <br />� <br />�a -��p �e � �U�' ���"""- � _�9 ACKNOWLEDGEMENT OF CONDITIONS <br />O <br />Approved tor ConsUuction <br />FINAL INSPECTION <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everelt, WA 98201 <br />Phone:259�P810 <br />�a[e <br />W <br />H <br />ew <br />_ / <br />Z <br />O <br />F" <br />� <br />0 <br />a <br />/y—� G <br />The undersigned owner/apPlicaN hereby agrees to hold and save harm- <br />less the City ol Everett irom any and all claims for damages. costs. <br />expenses, or causes of action iha may arise because of inslallation <br />and mainlenance ol the improvemenl or other r�ghl•of-way use hereto <br />applied lor and furlher agrees lo remove same upon notice Irom Ihe <br />City and to replace public property damaged thereby. <br />ure ol APplicant <br />Date <br />WOf;K FlUTHORIZED BY THIS PERMIT MUST BE STARTED �VITHIN <br />780 DA'!S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �dAY BE <br />CANGELLED BY TFIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />