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Date) TO POSTING 1�-1------�/ I Public wo,waPermit + <br />Bldg Dept <br />Application For <br />PUBLIC WORKS PERMIT <br />Public Works ran S <br />Total Fee <br />Less Abpt Fee Paid $ <br />Balancb Due $ II I <br />Print or Type Only VA <br />Applicant <br />Mailing Address City Zip Phone <br />Describe Proposed Work fa Pill 9 <br />Project Address lit known, 2�o3I 6 ,-aA6 Atw- <br />as <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the enllowing of applicable: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and •Show any proposed grading changes <br />proposed structures the tot • Show measurements <br />• Existing and proposedd utilities <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 />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />ill Slope, perk?nl IA- -6* bpsih• <br />driveway aPrbns rnu�t hx rc►ho�ed <br />'J• <br />Al <br />An Unu4e_d <br />al�d IzP�d <br />w� hfUll hail iurb,qu, ,r �t av <br />Ali brokan or �iavna9td e—uvl �}u��✓ o✓si���lel k Mall <br />bG rGPlacGd ,r r^tw d;larkion of I'bhG P bl;r, Works in�� V' <br />.Approved for Co tructio� Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />ca <br />O <br />n <br />z <br />O <br />CA <br />O <br />a <br />The undersigned owner/applicant herebv 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 f her agrees to remove same upon notice from the <br />City ar d to rclic property damaged thereby. <br />,�%i§naIN <br />ORK tur of A is t —�� Date <br />E S <br />B0 DAYSTOF ATE PERMIT ISZEDBY THIS EISSUED ANDS HFREAFTER yISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY S . OPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />