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Date � -/ -%D <br />PUBLIC <br />Print or Type Only <br />� <br />� <br />� <br />Applicatf+un For <br />WO�KS <br />O <br />L <br />� <br />N <br />..� <br />.-1 'r <br />PERMIT <br />8 O <br />N N <br />+A N <br />PubLt Worxs Peimil • / C � — • � <br />Biae� Deo�-+ <br />Pu�l¢ Nb�ki Fee <br />TatTl Fee s <br />Lass Pppl. Fee Pa�d S �7 <br />BalanceDue s p��00 <br />002 -3ZZ -Yo-OoO-/S-8s'/ <br />Owner Ma �Ng d � City Zip Phone <br />� � � � r 3Hd• 13�0 <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Proiect Address lif known) <br />Attach four (4) copies ot plans lor proposed work • Draw to scale and note ihe following as applicable: <br />• Property Lines <br />• Outline end dimensions of all existing �nd <br />proposed structures on the lot <br />• Existi�g and proposed utilities <br />• Centerline ot slreet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be mede 24 hrs. in advance - phone 259•88� O. <br />2. All work shell be performed in accordance with this permit end current City of Everett Design and Conslruction <br />Standards end Specifications. <br />3. Cell Locetion Underground Service 48 hre. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />� COr�I-...��r� �oc/f.�,� �� � n� �� �� �A� '�315� <br />�`o�� �..���, <br />✓� ./Poe� .s+i��" eo��-aL�C.-e.eQiii �'J/og%a�r.z.Ci�n.u�rsv <br />1%.c/ T�o»>, cCl�v 6� �D4o� �a���c�„aT-f. <br />FINAL INSPI <br />Approved as <br />everett <br />e <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�BB10 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicant hereby agrees �o hold and save harm• <br />less Ihe City o� Everett from any and all claims for tla:nages, costs, <br />expenses, or causes of action that may arise because of inslaltation <br />and maintenance of the improvement or other right-obway use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />Cily and to replace public property damaged thereby. <br />' wLt � ( �i4—^�� <br />Signatur ol Ap icant Date <br />WC1RK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS �SSUED 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 />