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Date���� Public Works Permit# 13 oL? <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public <br /> bTota Works <br /> Fee ee $ - =- <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due ,$ 2 a . CO 0 <br /> t+ In, Carr R700 f"1b+ Aoe SE. k (Ua. 9'880 �8-a43I <br /> ff ner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work .,„57c- �- re,/L.0 e.l"0 7 CSC' X/f P ®/` <br /> ,2"L.. /---/ G 6-.,_" 4.. . c i Gc cr, p c.- f"/GL f/ .) ll�j'.GS% <br /> ,41-i ".-7 .---, , d-,---",--431t---C..3",./.6. n,o,err.:Qj /‘.S1 ANIIIIIIt Q,' ..,,77c24tc.filt=W:). ....N., <br /> . W <br /> Project Address(if known) 7,4 —, /2J0/(:"T'c ,311 <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: ill <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CC1 <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8815. <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 /> 4 t i 1 Y •J L S vt.04- 10/o Ck S e 2.4-, S L el e w.1 LC. <br /> Of C1.L' ! 0 <br /> COIlli <br /> 0 <br /> a <br /> • <br /> simmino <br /> • <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 /> /-/2_cF3 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 /> pproved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date '1 5/y� //"ir43 <br /> Approved as Constructed Signatu of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259 8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> / PROJECT OVER 90 DAYS DURATION. <br />