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Date � - � <br />Application For <br />Pl16LIC WORK.S PERMIT <br />Print or Type Only <br />/� ;� � <br />��, <br />O++ner <br />�=i/ _'/"� - <br />ng <br />. i ,.. <br />Zip <br />a�o:�� wo,k: r�•,��n � <br />r. I�� � '�' � J <br />BI09. DeOt y 1 L��"� <br />Public Warks f'ee <br />Total Fce g <br />Less Appl Feo Pald 5 <br />Balance Ouc $ <br />�, - , (. � i <br />�!'�, l 11-� - <br />Applicant Mailing Address Cily 2ip Phone <br />� _� <br />Describe P�oposed Work <br />Project Address (if known) <br />Atlach lour (4) copies of plans for proposed work - Draw to scale and note tu� ;ollowing as applicable: <br />• Property Lines • Centerline of street <br />• Oulline and dimensions of all exisling and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremeNs <br />PERMIT CONDITIONS <br />1. All calls for insper,tion shal: be made 24 hrs. in advance - phone 259-8815. <br />2. All work shall b�; performed in accordance with ihis permit and current Ci�y of Everetl Deslyn and Construction <br />Standards and Speci(ications. <br />3. Call �ocation Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />'�I,-s /�JrOI�f�7'" !f /ri � s�/l'C 7"Cl//f�.��'�` <br />QC/ yl d�✓ ISSU ��r/Hr L L' n�� � / x° r i-� �r-- � r <br />. <br />«��' <br />SGp��" 8�� <br />i �_����� ��e - -- � <br />!� <br />J �� i '''r' crz �C' v'�' !'� <br />/ <br />'l. /=��� <br />Approved �or Construction Date <br />FINAL INSPECTION <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98207 <br />Fhone: 259�8815 <br />Date <br />� '��u;:1� ��d„ .,/«� e Cv �T� <br />�� <br />W <br />� <br />_ / <br />1� <br />� <br />� <br />LJ <br />� <br />� <br />0 <br />a <br />AGF:NOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City o� Everetl irom any and all claims for damapes, cosis, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance ol lhe improvement or other righbol-way use hereto <br />applied for/ and turiher agrees to remove .same upon notice Irom the <br />City and j6 replace pubijc property�damaged thereby. <br />Si�6ature of Appl'want -� - / / Date <br />iMORK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br />� 180 DAYS OF DATE PERMIT �S IS3UEC AND THEREAFTER IS TO <br />' BE DILIGENTLY PURSUED TO COMFLETION. THIS PERMIT �v1AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PPOJECT OVER 90 DAYS DURATION. <br />