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Date S-Z3- Public Works Permit r :741.7": <br /> Application For Bldg.Dept.* <br /> PUBLIC WORKS PERMIT Public al WorksFee $Less Appl.Fee Paid $ <br /> Print or Type OnlyBalance Due $ — <br /> .� a )o �, i9 '�) : l�� 40( — . <br /> Owner a ing Address City / Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> i 1 r ,, t 6 <br /> Describe Proposed Work 4) Z '-�N i�.Y`�!r 4 � �„2-- e'"f f„t.�.�^ a--kc-- /r.�UA 11 <br /> .647Y1 f. ?elm . {�. <br /> VMMINIMIllia <br /> LIU <br /> Project Address(if known) 6xt.C11..11 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: iimmil <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CII) <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. =oft <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction 4 <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> C <br /> CC <br /> C <br /> CL <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> tiC\j/f <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 /> f C-(CQ---(2. g — 3d- j and maintenance of the improvement or other right-of-way use hereto <br /> Approved for Construction Date applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> t 1 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> l Phone:259 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> wmismit <br />