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I <br />Date / / Public Wort Permll <br />Dldg. Deer. a .--- <br />Application For <br />PUBLIC WORKS PERMIT PubTaW Fee Fe s <br />lPeed s <br />s <br />Print or 7ype Only <br />Owner 1 Mailing <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <br />:,mach 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 />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs, in advance • phone 259.881 5. <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 "..; hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />FINAL INSPEGTIUN <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />Date <br />S/ t Efd�il% <br />y <br />Y <br />� <br />F35 <br />1 m <br />W <br />R, <br />0 <br />r <br />co <br />m o <br />—I c <br />o� <br />m <br />Z-I <br />S <br />m <br />ca <br />D <br />r M <br />O <br />q D <br />1 rn <br />m <br />Z <br />N <br />O <br />r <br />o r <br />M m <br />Q <br />T N <br />rn <br />r'n <br />z n <br />—1 r <br />m <br />x <br />a <br />z <br />am <br />N <br />Z <br />O <br />--I <br />n <br />m <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 f0 nd further agrees to remove same upon notice from the <br />City a�ojr place pubji5�perty d�f'aged thereby. <br />WORK AUI(HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 />