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� <br />� <br />Date�9� y <br />O <br />PU�IC <br />O <br />O <br />Print or Type OnIyM <br />M <br />R C Coleman l� 51� <br />Owner M � <br />.-1 <br />� <br />Owner � <br />Applicant <br />Descr�be Proposed Wo�k _ <br />Application For <br />WORKS PERMIT <br />IiJ 00p1�1 Op U O�td� <br />�O NN N `�O M /7�1� <br />N N M N a! Y a W M� <br />Oo 11] M <br />����1�������� <br />Mailing <br />.�- � -z8-s <br />982yG <br />City <br />/ <br />Pu�iic Works Parmit s �/41 Q <br />BIOg. Dept y 90/25408 _ <br />Pu01ic Workg Fee <br />Tolal Fee $ <br />Le59 A00�� Fm Paid S <br />BalanteDue $ Z'v_ <br />4£i1-3055 <br />Zip ?honc <br />Zip Phone <br />Projecl Address lif known� �t3 - SP 51-89 � 1 S MA P � S<^t�i ST <br />Atlach four (4) copies of plans for proposed work - Draw to scale and note ihe �ollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existin� and <br />proposed sVucWres on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicale North <br />• Show any �roposed gradinc� changes <br />• Sl�ow measurements <br />PERMIT CONDITIONS � <br />1. All calls (or inspection shall be made 2a hrs. in advance- phone 259•8810. <br />2. AI1 work shall be performed in accordance with this permit and current Ciry of Everetl Deaign and Construction <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. �efore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� VVj `lC� B�ZL�o <br />Approved for Constructi n Date <br />� j� � <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200Cedar5lreet <br />Everetl, WA 98201 <br />Phone:259-BB70 <br />ACKNOWI �D3EMENT OF CONDITIONS <br />W <br />� <br />—/ <br />� <br />r/ <br />�w <br />� / <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City oi Everett Irom any and all claims lor damages, costs. <br />expenses, or causes ol action that may arise because ol installation <br />and maintenance ot the improvement or o�her right-of-way use hereto <br />ap e for and Wrther agrees to remeve same upon notice lrom the <br />Ci an to replace pub � periy damaged thereby. <br />� <br />Si�nature of ApFlicant Dale <br />WORK AUTHORI�ED BY THIS PERMIT MUST BE STARTFD WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PL'RSUED TO COMPLETION. THIS PEfiMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />