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Date 7 D—F 7 Public Works Permit <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Pubic Works FeeTotal e $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due $ <br /> /1c7 /e C CC,A., 2 0 Z,e) .r am d A ejz C` /7? 7e ..3-?L 8C <br /> Owner Mailing Address City Zip Phone <br /> rat <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work re ,\ ,) <br /> Pre/ a b f e - IMP 04 — �--"h ' ` 044.4c1 Cal" !I ftk, <br /> w <br /> Project Address(if known) <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 BELOW THIS LINE 0 <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. z <br /> 0 <br /> Cn <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 /> cluJai 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 /> Approved for Cons y- tion Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date 7—Zel-rr 7 <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> Street3200 Cedar 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 9 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA <br /> Phone:259-8810 A0 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> / PROJECT OVER 90 DAYS DURATION. <br />