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I <br />r <br />Date I" <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner Mailing Address <br />Mailing Address City <br />Describe Proposed Work <br />Project Address (if known) <br />L <br />Zip <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />jai <br />Public Works Permit is <br />c� <br />Bldg. Dept. • _ <br />S <br />Public Works Fee $ <br />Total Fee <br />wr <br />Less Appl. Fee Paid S <br />aamnce Due $ <br />[a4D d7-,6eI,a <br />7o <br />23� <br />• Property Lines <br />• Center!ine 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 />1. 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 />Tn ae CO.vSfrccc�ep� u S �r,r PC4r,S <br />ayo,z, ro ve ad oa <br />aSs"3 <br />LU <br />1 <br />N <br />M <br />LM <br />0 <br />z <br />O <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <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 />Approve r Con uction Date <br />77 <br />f <br />FINAL INSPECTIOO <br />U <br />Date <br />gignature of Ap lican to <br />Approved as Constructed <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />erett PUBLIC WORKS DEPARTMENT <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street <br />le <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8815 <br />PROJECT OVER 90 DAVS DURATION. <br />