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B6— ZGB <br />Data Public Works Permit e <br />Application For sloe Dept <br />PUBLIC WORKS PERMIT Pubhc Works Fee <br />Total Fee $ <br />Less aPPL Fee Paid $ <br />Print or Type Only Balance Due-- <br />C l55 7 /b V11AIEy 7 /DEL LE��CO� wA 9�D <br />Owner Mailing Address City Zip Phone <br />Applicant Mailing Address City Ziip) Phone <br />Describe Proposed Work <br />LU <br />Project Address (it known) <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 />• Outline and dimensions of all existing and • Indicate North <br />Proposed structures on the lot • Show any prcposed grading change:; <br />• Existing and prcposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE ' <br />PERMIT CONDITIONS O <br />1. All calls for inspection shall be maue 24 his, 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 SpecificatiDns, <br />3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800.424-5555. <br />C Gq To GL='ED /O� Df' ,f'-O-CtJ- O <br />S PL�c q V7 Tv Sind 4/4- CO(/E.vi9it/T <br />5Eiu7- Tu Are"-,-F 6- 2/7 I <br />Q <br />a <br />Approv -for Construct' -for Construct' _ Da ` <br />FINAL IN5P CTI N If Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <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 />Signature of Applicant — tl Dille <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 r0 COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />