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QateTl- f_& <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Weeks Permit a <br />Bldg Dept a <br />Public Works Fee i <br />Total Fee <br />Less Appl. Fee Paid tt <br />JS �O <br />Balance Due <br />l�­00 E./B✓L4 cQZp(,> 14- <br />Owner Mailing Address City Zip Phone <br />Applicant Mailing Addr ss <br />City Zip Phone <br />Describe Proposed Work <<'N 5-}'t�Jc.-'� q S rX (camrX ��' r 17..' lee %a'e �c'Lrbty <br />hI uLC ei5 4/ (.(�l�LFOV Lem <br />Project Address (if known)-TR✓-r-rrL y (t�4.� {� <br />I. l'o IC7 L- <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 proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. 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 Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />�• !r7Ci El/ fib HJ-- OF- Lc./yc !o'r H.n/v %/�/S /�ZoTECT <br />/S Tu e'E L:•�,��'ovE' � /�Fi2 C/Tj/ STA�k/09f_1J �-�'L'� <br />Si Jc-cc!4cC iS %U Bf _?k-'ST9CGeO VEf//1/Q t7d FXiSTi�'� <br />/wee e//-y <br />_47 /S To Pod%oE .9 �E�Fa�n/cE (su9eA✓r� <br />crJoe E le BE Dave /.✓ %ile /1eis[�C Rl6w7-- of- e110$/ <br />W <br />O <br />z <br />O <br />O <br />a <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 />7 �G 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 />Ap ovefffor Construction Date City and to replace public ptIn f(y damaged thpireby. <br />FINAleIMPECTION Date _ - - �sl <br />�r— <br />Approved as Constructed — 5 ure o ppIicnnt Date <br />everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. <br />