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Date <br />Applitatlon For <br />PUBLIC WORKS P��MIT <br />Plan Check No: B 4/206/7 SEPA <br />Print or Type Only APpJob�llddre� 6327ZPbLR PL <br />Ownars POWSLL TfiRRANCE L <br />Tonant: <br />��c�ofdWorks �TAZNING WALL <br />Owner RfiTAININ6 WA;L <br />Appllcent <br />�, Deacribe Proposed Work <br />Project Address (if known) <br />r� <br />PuElle Work� Perm11 r <br />BIaO. DIPI � _ <br />Pubiic work� Feu <br />Tolsl Fee : <br />Leu �ppt Fea P�IU i <br />B�bnce Due i <br />Zip Phone <br />OFFICS SfiT JOB SET <br />APPRVD FOR FSRMIT: DATfi_/_/_ HY Zip Phone <br />Attech four (4) copies of plene for propoaed work • Draw to scale and note the tollowing as appliceble: <br />• P�operty Linea • Centerline of street <br />• Outline and dimenalons of ell existing and • Indicete North <br />�ropoaed afructurea on the lot • Show eny proposed grading changes <br />� Exfating and propoaed utiliNea • Show measurements <br />PERMIT CONDITIONS <br />1. All cNla for Inepectlon ehall be made 24 hra in advance - phone 289�8810. <br />2. All work sAsll be peAormed in eccordance with thia pertnit and current City of =verett Desipn and Conatruction <br />Standarde and Specifiutiona <br />3. Call Location Undarqround Senice 4B hra before you dip. TOLL FREE NUMBEl11-800�4245555. <br />PUBLIC WORKS PERMIT <br />NOT REQUIREO <br />@Y <br />DA�E � 3 <br />' Approved tor Lonstruction Date <br />FINA! INSPECTION Date <br />Approvcd as Constructed <br />�PUBLIC WORKS DEPARTME�IT <br />3200 Cetler Street <br />Everetl, WA 98201 <br />Phone: 25&BB70 <br />ACKNOWLEDGEMENT OF CONf ITIONS <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City �i Everett from any and all claims for dameges, costs, <br />ezpenses, or causes of ac�ion that may arise because ol installation <br />and maintenance of the improvement or other righPoh�vey use hereto <br />appiied for and further agrees to remove same upon notice from the <br />Ci,i and to replace public property damaged ihereby. <br />Signature o( Applic�nt Dete <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEFi IS TO <br />8E DII IGENTLY 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. <br />