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Date 3 �23 —90 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typs �nly <br />Puoo:worxsFcimiia ��/�� <br />eme.oeo�., ����332f�1 <br />PuOLc Works:ae <br />Total Fee $ <br />Less AOpL Fec Paip 5 r�� <br />Balancc Oue $ <br />�Kl' <br />\\/�ST SdJi�t� Cfi�1�1ST'�UG't--IO+J �%c3dC ZCsSrj \1/A <br />Owner Mailing Address City Zip Phone <br />�203 <br />Applicant <br />Describe Proposed Work <br />Mailing Address <br />Project Address (if known) 14' Z <br />City Zip Phone <br />Attacl� !our (4) copies ol plans for proposed work - G:aw lo scale and nole ihe lollowing as applicable; <br />• ProperlY Lines <br />• Outline and dimensions of all existing and <br />proposed structures on ihe lot <br />• Existing and propased utilities <br />• Centerline of street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measurements <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 perfermed in accordance with Ihis permit and current City of Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />4.,4-c.��t c�..rs S Et�� � r.�S-t-�t..� <br />STP• � 2vO� <br />�C7�� ��-�e.-e_ `� —Z3--RJ <br />Approved for ConsiruJction / Date <br />/`-'� '��' "`� r�C —.Z U — % <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />evere[t PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 38201 <br />Phone:259�8810 <br />i���.�C/t�' r-"�7Z <br />ACKNOWLEDGFMENTOFCONDITIONS <br />W <br />■ <br />_ / <br />� <br />O <br />Tha undersigned owner/applicant hereby agrees lo hold and save harm- <br />less the City ol Everett lrom any and all claims tor damages. costs. <br />expenses, or causes ol action ihat may arise because of in;�allatipn <br />and maintenance uf the improvement or other right-of-way use hereto <br />applied for ard further agrees to remove same upon notice Irom ihe <br />City and to replace puUlic properry damaged thereby. <br />� <br />l�7 <br />�lure of Applicant (� i 'ua[e <br />RK AVTHORIZED BY HIS PERMIT MUST BE STARTED WITHIN <br />80 DA`S OF DATE PERMIT IS ISSUED AND THFR�AFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BL= <br />CANCELLE� BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />