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Datef��`? 'B 6 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />5corr <br />� 5�: vt� t .- <br />�LEu <br />Describe Proposed Work <br />/ $ooy 7 3''`� i�/. � <br />Mailing Address <br />Mailing Address <br />,.—a.c„� �,,,,,, <br />Prolect Address (if known) J ' <br />: n4.- <br />Pu�licWoiksPermil• ✓� %7 <br />BIdB� Oept + <br />Public Works Fee $ r1� <br />Totel Fae � <br />Loss �ppL Foe Paid $ �?�q� <br />BalanceDue S (//�� <br />_��vacls �,'a i�oz� i7y-9a98 <br />Zip Phone <br />Zip <br />Attach four (4) copies of plans for propused work • Draw lo scale and note Ihe 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 <br />�U NOT WRITE BELOW THIS LINE <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 pertormed in accordance �vith this permit and current City of Everett Design and Construction �,�1� <br />Standards and Specifications. )� <br />3. Call Location Underground Service 48 hrs. befora you dig. TOLL FREE NUMBER 1-800•424-5555. ,� <br />�, %� o e�'.e-r/ GaYrs 7�, m'c � �-�r s f� �`3 z�� 3� <br />' 5��--eC� � aM �l j'/-Q! f1 [�dl��br i� i'< �b <br />�� � ���� <br />r�e r�,� „2 � �.�� �� , <br />� ��:�:_ �� <br />Approved tor'Construction � �Date <br />(� v,�->�p�: 9l�lg� <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259•8815 <br />W <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITION� <br />The unders��ned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everetl trom any and all claims tor damages, costs, <br />expensas, or causes ol action that may arise because ot inslallation <br />and maintenance of the improvement or other right�of-way use hereto <br />applied for and further agrees to remove same upon notice Irom ihe <br />Ciry and t- eplace public property damaged ihereby. <br />I <br />� � �� <br />SignaWre of Applicant ate <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 />