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I <br />r <br />L. <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />City Zip <br />Public Worke Permit • ✓ '-/��� <br />Bldg. Dept. 0 ✓ <br />Public Vor"Foe S <br />Tr..l Fee <br />Less AppL Fee Paid $ <br />Balance Due $_ 11, 5L� <br />'c'Ab9 <br />"none <br />Describe Proposed Work � 71�l O!�� Zo :r_H r CA -CT' O'F= <br />r <br />� I -T>dP_K/A-I& !_e-)T FxfmA/S/CIA-/. _ <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note 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 />I. 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 />To BE CoNSTi GtGTc>> As Pfn <br />A,V' p .[>erED <br />B- to - 15?SG <br />FINAL INSPECTION ' \ <br />Approved as Constructed <br />�everett PUBLIC WORKS D <br />3200 Cedar Street <br />�1 Everett, WA 98201 <br />Phone: 259-8815 <br />Date <br />P'14Al /IPf'zovc=� <br />ACKNOWLEDGEMENT OF CONDITIONS <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 />ture of Applicant Dale <br />ORK AUTHORIZED BY VISPERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS IS51JED 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 />r <br />n <br />—41 <br />