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Date! � 3 <br />Applicatii n For <br />PUBLIC WORKS PERMIT <br />Print or Ty,�e Only <br />��oe �- <br />owoer <br />Su-...-� �G a � <br />Applicant <br />Mailing <br />Mailing AAdress <br />� <br />u e cC p �' �'Vtfe <br />Ci;y <br />cny <br />Describe Proposed Work FL L �B� e y. _ <br />Projecl Address �it known) <br />Pupl.c Woiks Prrmn � �" � � ��� <br />Bl�p DeO�-+ <br />Puhlic Work� Fee <br />Tolel Fee S _ <br />I.r59/pplFcePOi� s �j _ <br />oalance Oue $ G�• 'SO <br />UOZ^.�=c — <br />�Y� <br />2ac3 �S <br />'P i,..,,.,k�n� <br />Zin Phone <br />Atlach fOur (4) copies of plans for proposed work - Draw to scale and nole the tollowing as applicable: <br />� Property Lines • Cenlerline ol street <br />• Outline and dimensions ol all ezisling and •!nd�cate North <br />proposed structures on the lot • Show any p�oposed c�rading changes <br />i Ezisting and proposed utilities • Show measurements <br />PERMIT CONDIT�ONS <br />1 All calls for inspection shell be made 24 hrs, in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current Ciry ol Evere!t Design and Construction <br />.itanderds and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5��55. <br />�� � ���h �.� � <br />� <br />Q�-�c�u-,,� �f.ftio D,a-c/IQY� •• <br />�e.c��� .t;v <br />o�w-.�4�1� <br />� .r„��i' �c �t� <br />��e� f� �,�j,�� �<�1��: .�, ����.� �;�(}1/88 12�03PN OOOAq2936 <br />� N000145U5 <br />DFT.20 422.50 <br />CHEC1: $22.50 <br />Approvedfor <br />FINAL INSPECTION <br />Approved as Construded <br />everett PUBUC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everefl, WA 98201 <br />Phone; 259�8810 <br />Date <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner�applicant hereby agrees to hold and save harm- <br />less the City of Everet; Irom any and all claims �or tiamages, cosis. <br />expenses, or cau=es N.�;tion that may arise because ol insi:llalion <br />and maintenance ol thc improvem n� or olher right�ohway use heielo <br />applied for antl lurther agree to emove same upon noticc Irum tha <br />City �nd to replace pu�ic pro�ert damag�,d Ihereby. <br />�- ` / v l/ — /� ^ <br />gn ture of Appli a t Date <br />ORI U 10R D BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJE::T OVER 90 DAYS DUAATION. <br />