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two'. <br />'W r <br />eftle. else, <br />Icc, <br />Dale_ �--1--., <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City Sweets <br />Mailing Address City <br />Public Works Parnell I __- <br />Bldg Deer. a 90/24839 <br />Public Works Fee <br />Total Fee s — <br />LessAPPL Fee Paid S — <br />Balance Due s __ <br />Millett Assoc 117 Summit E Seattle 98102 325-0646 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) 1 409 en 7yeref-F Mal l may — 41 0C <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 />DO NOT WRITE B <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 his. 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 />Approved for Construction <br />N8 Rfsuc- Vo✓LXs f?�l2g-=iD <br />�Pa z_ W1 C- La z_ <br />C�-18—_�)o <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Street <br />Everett,tt. WA WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />PAM <br />The undersigned owner/appticant 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 at other right-ol-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 />Signature of Applicant Date <br />WORK AUTHORIZED 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 />