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Date ��' � � <br />Application For <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />Pu�lic WoiAs Permil • <br />BI�B.OePI.• '� � <br />Puouc worxs Fee S <br />Talal Fee <br />less AOG� Fee Paid s <br />Balan:e Doe S <br />MikF R_ PJ�K�TT ZZ19 RAlill/ER AVL- EVGRETT WA 9BZ01 Z52-2v78 <br />Owner Mailing Address City Zip Phone <br />ABo v� <br />Applicant Mailing Address Gty Zip Phone <br />DescribeProposed'.Vork DEMOLISN EXIST/�t/C� GARAGE AAIO RtPLAC� W/tF/ <br />AItW CA14AG�' <br />Prolect Address (if known) <br />Attach lour (4) copies of plans for proposed work • Draw to scale and note the fotlowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• ShoW measuremen�5 <br />PERMIT CONDITIONS <br />1. All calls for Inspection shalt be made 24 hrs, in advance - phone 259•881 O. <br />2. All work shell be peAormed in accordence with this permit and current City ot Everett Design and Construction <br />Stendards and Specifications. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />�UBL/C G�v�s t=iF'.PM�T �t/O% .P�.c-QU��eE� <br />Approved for Construclion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CederStreet <br />Everell, WA 98201 <br />Phone: 259�BB10 <br />��/88 <br />�'�GC� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <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 ol Everett Irom any and all claims lor damages, costa <br />expenses, or causes ol action that may arisc+ bzcause ol installation <br />and maintenance of the improvement or other right-of�way use hereto <br />2pplied for and further agrees to remove same upon notice irom the <br />Ciry and to replace public p�operty damaged thereby. <br />Sic�nature ol Applicant ���e <br />WORK AUTHORI2ED BY THIS PERM�T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVF.R 90 DAYS DURATION. <br />