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Application Fctt� <br />�,UBLIC WORK$ <br />r� <br />C7 <br />Print or Type Only <br />�F <br />TO POSTING, Z-z1- <br />PERMIT <br />rn <br />a`u�ln <br />ifT h'i <br />Public Works Permit . Gr' <br />Bldg. Dept.. <br />Public Works Fee <br />Total Fee $ <br />Less APPt Fee Paid $ Balance Due $ 7 C <br />I • (07— <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work h 74��1 M&f GJCAe+ W^svl ADZ <br />LU <br />Project Address (if known) Z 115 S MA11 <br />Fru) <br />Attach four (4) copies of plans for propvAV <br />osed work - Draw to scale and note <br />the following as applicable: <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance- phone 259-8810. <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 h1rrss. before you dig. TOLL FREE NUMBER 1.800.424-5555. <br />170fm or- sM+: vmr Cie -awl tjlc- Ytat04- -Lhe. <br />��-d �1car, . �vv► coif Fr-erh �ha,. vtt�.sk �,r'G�, s►rw,bl <br />Ive <br />pe g coilootein 5664033«�t-�t��wt�► <br />a 4-1001LAbf, ,ry tcr) ( ra6 wo 4 1V,. c.�►d PUv► af,F <br />srd -7• �. <br />1n5t 1abVN SKIA mZat' e tO rmvrsv-tr of' I f r ChckArv-, <br />0ormOW 07 <br />PUBLIC WORKS DEPARTMENT <br />320o Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <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 />apiplieg,few, and further agrees to remove same upon notice from the <br />City nd to repXc�publ' rop rty damaged thereby. <br />qnature of Ai''plican Date <br />RK AUTHORIZE THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE nILIGENTLY 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 />