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Date <br />(�- -c1Lj <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />(t It <br />Mailing Address <br />Describe Proposed Work .pfi,(1 )L <br />Project Address (if known) <br />:3eab <br />Public Works ParrryLe � JJ <br />Bldg. Dept. a <br />Public Works Fee <br />Total Fee S <br />Less Appl. Fee Paid S <br />Balance Due $ << <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • 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 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />I, t`6:?.qGvF 96, 6L;_f7ZFaL f / l-'---14ALK yN AlzcA of l-wil c- , <br />/t Nlj l "STALL NE6./ DrZy li�i. JAY AACOAl <br />6i-AN011/jP5 <br />u-- 0C1VX1CZT l4 d0r= 'PZ-/tkl N f O/ l2cG T'c .t 7T0 <br />�p <br />ApproveBfor Cons q�tion % uate <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />P-We- C r ry cry l<Vt-7Y6 'T <br />5f 0C'SZeFt�f_w r <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ca <br />O <br />n <br />O <br />a <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 />i �-13-`70 <br />Signature Applicant Date <br />WORK WHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 />