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<br /> Date 1 -cii-- `i7 r Public Works Permit#
<br /> Application For Bldg.Dept.#
<br /> PUBLIC WORKS PERMIT Public Works Fee
<br /> Total Fee $
<br /> Less Appl.Fee Paid $
<br /> Balance Due $ 4163 1./MV1/- :
<br /> Print or Type Only -
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<br /> Owner Mailing Address City Zip Phone
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<br /> Applicant Mailing Addreess City Zip Phone
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<br /> Describe Proposed Work ?,...i p/,, A--", ;17 ,-,,,-z AN/_ livri.'71A A 8' 7-;::?1,I :9--, ii
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<br /> Project Address(if known) ,2 „.5 C' tc.' ?,A,7%,,,,, 4, 0.4.":44 z,...74-- i4:;., ca{- , , -trel A.-1-/eilia.,,,, I...
<br /> Attach four(4) copies of plans for proposed wok- 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 Cn
<br /> proposed structures on the lot • Show any proposed grading changes
<br /> • Existing and proposed utilities • Show measurements
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<br /> DO 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 III
<br /> Standards and Specifications.
<br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555.
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<br /> ACKNOWLEDGEMENT OF CONDITIONS
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<br /> ' i(1-,', ?...44e>,),,,-:'. . e .. ....j.,,,t. 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,
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<br /> il," 8 0 expenses, or causes of action that may arise because of installation
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<br /> / and maintenance of the improvement or other right-of-way use hereto
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<br /> applied for aid further agrees to remove same upon notice from the
<br /> Approved for Construction Date City and tb rePlace/lubitcproacrty damaged thereby.
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<br /> FINAL INSPECTION Date / Li:// i.:5"' ' (-,'",- ---
<br /> Approved as Constructed Sig'nature di ApplicAt Date
<br /> / \ WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN
<br /> everett PUBLIC WORKS DEPARTMENT
<br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> 3200 Cedar Street
<br /> Everett,WA 98201
<br /> • j Phone:259-8810 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.
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