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Date_OO/ <br />Z <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit s <br />Bldg. <br />Bldg. Depl.a <br />Public Works Fee $ <br />Total Fee <br />Less ACpi. Fee Paid 5 <br />ailarc. Due $ <br />�iilrotl C//„,, Owner Mailing Address City Zip Fhore_ <br />77, ,-1d JP <br />.5 <br />r' Applicant Mailing Address city Zip Phoi.& <br />Describe Proposed Work _ e���)��i.;1,ln 62i A�L.N /_ Y�Lr �i,/ _,1X1-Zp t X /4-----_--- <br />W <br />2�'pp"n.�� /J <br />Project Address (if known) �µ,c./—>I-����V <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />/^ <br />• Outline and dimensions of all existing and • indicate North <br />yd <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />CO NOT WRITE BELOW THIS LINE <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 />Call Location Underground Service 2.8 hrs. before you dig. TOLL FREE NUMBER 1-800-424.5555. <br />/3.. <br />/"ate Gvoz �` /Uol� x <br />�a <br />F.- <br />Approved for Construction <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />r�1 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersignei 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 />Signature of Applicant Date <br />WORK AUTHORIZED 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 />