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:--1 I <br /> Date A Public Works Permit �� �' <br /> Application For <br /> 'V � �` ��/ Bldg.Dept.# <br /> PUBLIC WORKI PERMIT Public Works Fee e $ <br /> Total:"Y. Less APp;.Fee Paid $ <br /> 8 Balance Due $ c7 <br /> Print or Type Only <br /> k. <br /> 0 e ; I r 4 3 0 i 4 s on 70 I Oakes . ve v ri I /2 / 2 8 367? <br /> Owner Mailing Alrasii:.. City Zip Phone <br /> 1 ( t r 86 8 t 6it r r I /' <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work & V A VC I fit v t Ve tj4/a7 <br /> maimiwo <br /> �.J <br /> �~"� � W <br /> Project Address(if known) 310 Z- 4 I e.s <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 • Cn <br /> proposed structures on the lot `,, • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CID <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. miii <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 /> Z <br /> 0 <br /> I— <br /> Cl) <br /> (in <br /> Om <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> C <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 /> e , or s ao my r base <br /> /1.4..., ) ,C �! and expens maintenances ofcause theof improvementctin that a <br /> or otheraise righec t because <br /> wayof use hereto installation <br /> f <br /> A! applied for and further agrees to rem s e upon notice from the <br /> Approved for Construction Date City and to replace p li erty dam g thereby. <br /> FINAL INSPECTION Date :',- � f�fii/' , <br /> �'��9 <br /> Approved as Constructed Signatur ,6f plicant Date <br /> • 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:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />