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Date Public Works Permit* <br /> Application For Bldg.Dept.* <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> . Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type.Only Balance Due $ <br /> W AS c,/i n Homes Inc, V I//o _C5. /aGoma LJty Tact /0 tci c?ye2 el <br /> Owner Mailing Address / City Zip <br /> • <br /> Joe s'c,Aney g?/fa 5&,7cbra telty7co c ye 99? ,-Fy-,ekl <br /> Applicant Mailing Address / City Zip Phone <br /> L I <br /> Describe Proposed Work roar C017cre. e -4,'a i 4P�i`On 4 ' ,2 f)' 40O 1i e o)/'!e <br /> o ,fie usa a dcci`rcer cad' C At C. Z Y. AZ c.7 ne,i.,`/€ 14( me ?a urt z'; �, <br /> a� Fe0v c1 ttc2cAis coca,,.>A,g� •___ <br /> p nc� / W <br /> Project Address(if known) / /f / ✓eyre>°r/ Lazy ) t'" eYsellim <br /> Attach four(4) copies of plans for proposed work---JJDraw to scale anted note the following as applicable: iii <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and •Indicate North Cn <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. n <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 /> 0 <br /> CI) <br /> 0 <br /> a <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 /> Approved for Construction Date applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett <br /> e PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 <br /> treeBE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259 8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />