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ate �-�F-94 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />Jeff Gray PO Box 975 S. <br />Owner Maifing <br />Owner <br />Describe Proposed Work <br />Projec� Address (if known) <br />� (�-3C�-2q-4 <br />M <br />�P�I�G '��� �f� <br />� <br />g NOtlO1�CJ <br />vai iricoo��a <br />t7 �'+ .-� OJ .-+ Nv C+1 <br />r-� .-1 N +P +A <br />.t .-i +R <br />Mailing Address <br />new house <br />� <br />O <br />N <br />�Q <br />� <br />PUGIic WorMs Parmit e �� O�Z <br />e�ec. oeo� _ — 43�-�t � <br />Pubhc Wods Fee <br />Total Fea $ <br />Less FpD� Fee PaiE $ <br />p �y �ylanceDoe $ � <br />O d'C-- <br />:� n m <br />OJ M O� <br />W C�J <br />Ci!yx _ m o� ug� Phone <br />�' o,�ao�wr� <br />'V U' '.i [.D !c: 3 O <br />OlilL)� U1�01-0[�3 W <br />�Jli., CGO¢O�'+W 2 <br />a � i� G]O�C3�t�'+fnU <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note �he lollowing as applicable: <br />• Property lines <br />• Outline and dimensions of all existing and <br />proposed slructures on Ihe lot <br />• Existing and proposed utilities <br />for <br />zoz- �- <br />• Centerline of slreet <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 performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Speci!ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEH 1-800•424-5555. <br />� G� <br />FINAL INSPECTION <br />Approved as Consiructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />Z -24-q'� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />N <br />� <br />O <br />�w <br />�/ <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Gily of Everetl Irom any and all claims for damages, costs, <br />expenses, or causes of action thal may arise because of ins�allation <br />and maintenance of lhe improvement or other right-ohway use herero <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public prcaerry damaged thereby. <br />Signa ol A r ant Date <br />WO K UTF RIZED BY THIS P RM MUST BE STARTED \'JITHIN <br />180 AYS OF DATE PERMIT IS I SUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />