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407T1� <br />April For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-6810 <br />TYPE OR PRIN r ONLY <br />Gp <br />Date_ <br />Public Works Permit If <br />Building Permit A <br />Public Works Fee $ 2,0 <br />a 4 G 12 M I PN tc EU�`ZI W71 Z3 7 sg �} G P 8' <br />O�wner�l Mailing Address City Zip Phone <br />pica' n' V v v� Mailing Address City Zip Phone <br />Describe Proposed Work <br />W <br />'Pv6C%c. <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot "Existing and proposed utilities <br />-Centerline of street "Indicate North •Show any proposed grading changes -Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Undel ground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />/• lXe dcv/�cr SLili� 6C �CSPonc�u �C TOr rerno van <br />r+e 6LG zvu-LC �7r is ei11 evex heeds �a <br />J� �Ljls Gclo� 4 LSD fCpU//L� e7 <br />S z 9s <br />roved to ien D to <br />INAL I SPECTION Date <br />Approved as Constructed <br />i:6-0 -9E <br />::51PM <br />it <br />98138 <br />0114ER <br />20.00 <br />0 <br />59021 <br />BUILD <br />22.00 <br />SRCHS <br />4.50 <br />46.50 <br />ACKNOWLEDGEMENT OF CONDiTIli 46.50 <br />The undersigned owner/applicant herebytagreps to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action the may arise because of Installation and maintenance of <br />the improvement or o: �, right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />--- 3 — l <br />Sign4ye of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />