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Date 1- I <br />Application For ;TC POSTING <br />PU13LIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permil a • ,' / <br />Bldg. Dept. <br />Public Works Fee <br />Total Fee S <br />Less Root Fee Paid S _ <br />Balance Due $ � J <br />J. Lyle Romack 222 E Driftwood Shores Camano Is 98292 387-3945 <br />(�2�i XHYSC9iYSF1If)D1L1tXXXXALYF!>�ACYY YQY IpitvtwrYxf�2v vduUG47mLLvRrv�f. oannunnwx�.�n�iLY. <br />Owner Mailing Address City Zip Phone <br />J.L.,('�ti�tu•Ic:- <br />LY%2.2 -l.• CRIE=TfrrT'fJ CA&jw—Irl f,-,L =A7.�,Qzlr- <br />Applicant <br />Mailing Address <br />Describe Proposed Work COtJ(JT12 7C-T HEM <br />Zip Phone <br />LU <br />Project Address (if known) d`2L W plr•.- M, _ 'v20 <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 <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS O <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. 0 <br />2. All work shall be performed in accordance with this permit an I 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. z <br />9,T;g►,t L'in2 raof 8v-a'.n% to r-oc-k-F;IIed 1nF:lir�+��`e� O <br />�rey+ch . <br />• S (EIZ. P1TjGIVS Or S"ClC.1 —PLr\T, <br />O <br />a <br />Approved for Constru11011 Date <br />3-2 <br />FINAL INSPECTION <br />Approved as Constructed <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 />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 replace public property damaged thereby. <br />Ml <br />Date <br />ORK-AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED 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 />PUBLIC WORKS DEPARTMENT- <br />3200 Cedar Street <br />Evei ell. WA 98201 <br />Phone: 259-8810 <br />