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Applical on For <br />PUBLIC WORKS PERMIT <br />TYPE OR PRINT ONLY <br />A.ws+catr. D--st..l <br />Describe Proposed Work <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />.65• y 3nof <br />Sf: <br />y 6Kw� a3R <br />City <br />Data <br />Publi, Works Permit # /O <br />Building Permit <br />Public Works Fee $ JJ <br />9yoz/ <br />Zip Phone <br />A (z44)raa�j <br />PROJECT ADDRESS (if known) t"t eGArrT- lk e+.� jr- AWriaY /'6e+•AC�� QArot sVM jZ4J <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following ol ap�able: lO& `S P 'J-. <br />EwposedG2 <br />•Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centedine of street •Indicate North •Show any proposed grading changes •Show measuremer.ts <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 />FINAL INSPECTION <br />Approved as Constructed <br />03/19/96 9:05AM <br />400096107 <br />OTHER $35.00 <br />CHECK $35.00 <br />W <br />'1' J <br />z <br />0 <br />0. <br />am <br />ACKNOWLEDGEMENT OF CONDITIONS <br />the undersigned owner,applicant hereby a5. ees to hold and sawn harmless <br />the City of EvereV from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and furtYrr agrees <br />to remove same upon notic�e� 1(from the City and to replace p tl' property <br />71 came <br />signitureo plicant—Date <br />WORK AUTHJRIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILKIENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY 7OPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />