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Date <br />Application For 14 `(/")]�39 I� <br />PUBLIC WORKS PERMIT <br />Print or Type Only ,1 <br />G'EoRGE Q i%ar'NLbf 2Vm ' *-k <br />Owner Mailing Address City Zip <br />�Sa A}E #6 4ww- <br />Applicant Mailing Address City % Zip <br />el <br />Describe Proposed Work Alm oaets/ '" `I'V <br />Public Works Permit • '51 — <br />Bldg card <br />Public Works Fee $ <br />Total Fee <br />Less said Fee Paid $ <br />Balance Due S 20 z!_0 <br />3S5' - rx— <br />•282 <br />Phone <br />( r ,4 Cry -tom , /Vo7f_ 2 - Ai Uj� ltl -Z& :YK Y—FWl tY — <br />Project Address lif known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <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 Speci(c Dns. <br />3. Cell Location Undergloi.1.id Service 48 hrs. before you dig. TO1LL� FREE NUMBER 1.800-424.5555. <br />'7. S��"e �wl� c.•. ��Joivv.Tw. Pw.f� w.4 4kc <br />C�wbl,, Wo�l��—T�N��ecit ?'IZI 02 �v <br />Approved for nstruction Date/' <br />61< <br />F ECTION Date <br />'Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />0 <br />z <br />0 <br />0 <br />a <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 />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 />City and to replac <br />e <br />public property damaged thereby <br />S� <br />Signature Applicant Date <br />WORK AUTHORIZED BY THIS PER I MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISS ED AND THEREAFTER IS to <br />BE DILIGENTLY 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 />