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Date��//n / �1 /J <br />Application For <br />PUBLIC WORKS PERMIT /r l yog <br />Print or Type Only TO POSTING 1-71-43 - <br />Owner <br />/ J' 36 /k.1`- "'-' <br />Address C <br />ME <br />Describe Proposed Work /— f-Jr LOd CIA C E"Ori Mt4 <br />s 7/ <br />Public Works Permit * A/ ` <br />Bldg. Dept. Y <br />Public Works Fen <br />Total Fee $ <br />Less Appl. Fee Psid $ <br />o �/S <br />Balance Due $ <br />3.S <br />Phone <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work _ Draw to scale <br />and note the following as applicable: <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <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 Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />FINAL INSPECTION/. I <br />Approved as Constructed S�pfrb" I <br />CLPUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />u <br />//>bju <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 />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 />City and to replace public property damaged thereby. <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUE'.) 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 />