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r <br />Date �—G -� 3 1�J�� : � c � _ � , . <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />� <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />�1G'� <br />ng Address <br />Attach tour (4) copies ot p�ans lor proposed work • Draw <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />��) <br />ciry <br />City <br />Pu�lic WarkS Pa�mli s� I 3 3 <br />eme. oac�.. <br />Pu�lic Works Fee — O -- <br />Totel Fee S <br />less Appl FBB PaiE .i — � ^� <br />� Q �— <br />ealance Due S <br />scale and note the following as applicable: <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />.3�3 <br />5 i �� <br />Phone <br />Phone <br />PERMIT CONDITIONS nI <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 �sign and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEq 1.•�00•424-5555. <br />;.ic i� i: <br />RCS«i��nc� Ar��c w���� � _ __ (��r�`; ;,� j <br />��-irFt1cc �hr�'.inyS�Ri� <br />for <br />��;�„���,— <br />� 1 ,1 I <br />, � -. <br />�_____..._ _/'w�,�z x 4�f��.c.�h''i_ <br />_� <br />1 <br />,: <br />-G-� <br />FINAL INSPECTION Date <br />Approved as Construcled <br />evem(t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evereu, WA 98201 <br />Phone: 259-8815 <br />_ �I - <br />' ` v <br />- � <br />� �3�/u" I' j;��c. <br />aC <br />.� - 0� <br />' 1 I � <br />W <br />H <br />� <br />� <br />0 <br />� <br />� <br />,..r. _ __.. � ' Oa <br />i1���sE I. � L� <br />�, � <br />,.. <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 ihat may arise because oi installati�n <br />and maintenance of the improvement or other right•ohway use hereto <br />applied for and luriher agrees to remove same upon notice from the <br />Ciry and to replace public properry damaged thereby. <br />1 <br />��� �. �.,� /- G -�� <br />Signa re ol Applicant Date <br />WO AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 OAVS 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 ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. J <br />