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Date 6/18/85 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type On'% <br />Public Works Permit a <br />eida.DepLe 85/14922 <br />Public Works Fee <br />Total Fee $ <br />Less APPL Fee Paid $ <br />Balance Due $ <br />Ramona Boylan 6917 Evergreen Way Everett 98204 353-7770 <br />Owner Mailing Address City Zip Phone <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Addition to existing structure <br />Project Address (if known) <br />6917 <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 exis Ing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <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 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />Aea�c A <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />I <br />W <br />M <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 thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST 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 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />z <br />0 <br />M <br />m <br />H H <br />tn I <br />N x <br />v <br />m <br />cv <br />my <br />—I c <br />O 3 <br />m <br />2 —=1 <br />m <br />H <br />A Z <br />a —I <br />rx <br />H H <br />�N r'I <br />vz <br />�T a <br />—I m <br />x <br />mN <br />oM <br />= rrL <br />N <br />3 N <br />m <br />zn <br />—t r <br />m <br />a <br />A <br />2 <br />a <br />