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mr"'�-nm <br />TO POSTING <br />TYPE OR PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />JUL 3 1 2013LIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />r coOO r 5- v <br />2 tO lrO'���)7 tL qW o� <br />IN.61 1 Wrn i-.H1 R V_ �1 <br />6 <br />CJ <br />DaN 12/22/97 <br />•u <br />P `Lubk'1'c Works Permit It ! ✓ O <br />Bing Permit If __ 57508 Public Works Fee $ _ 7 / I r `�.0 `�e <br />r,'ry <br />Owner Mailing Address - <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />92658 <br />714-852-6691 <br />Phone <br />Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />"Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />IlCenterline of street •Indicate North -Show any proposed grading changes 'Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4 A Per �TPfrzwe% f, /?;4S d4&ecl-1161,61 <br />C0 <br />co <br />0 <br />NO <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneriapplicant hereby agrees to hold and save harmless <br />4 / the City of Everett from any and all claims for damages, costs, expenses, or <br />(� causes of action that may arise because of installation and maintenance of <br />App v for Construct Dae the improvement or other right-of-way, use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged Cher <br />FINAL INSPECTION"'Ntt{AAA,,,... Date 9 <br />Approved as Constructed <br />WORK R IS To <br />COMPLETION.RTHIS PERMIT MAYBE CANCELS ED BY THE CITY E STARTED IUPON ANY STOPPAGE OF WORK ON THIS PROJECT N 180 DAYS OF DATE PERMIT IS ISSUED AND VEY PURSUED TO <br />R 90 DAYS DURATION. <br />