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Date�� <br />Application For <br />PUBLIC WOR�(S PERMIT <br />Print or Type Only <br />Applicant <br />Describe <br />Work <br />Project Address (if known) �Q � Q <br />Mailing <br />cuY <br />City <br />Puclic Worke Perm�l • d S /7 0�— <br />BIOp. DeO�. • <br />Pu01ic Warke Fee <br />Totnl Fee S <br />Leas Appl fea Pald S <br />BalanceDue S ��s�� <br />k/4 �O) �10 <br />Phone <br />� %/ �G�O <br />Phone <br />L�1� � �l <br />r <br />Attach four (4) copies of p�ans for proposed work - Draw to scale and note the following as apP�icable: <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 />PERMIT CONDITIONS <br />1. All calls tor inspection shall 5e made 24 hrs. in advance - phone 259•881 5. <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. TULL FREE NUMBER 1•$00•424•5555. <br />� ,�PG�fd.vT GU/GL %AKE OvT S< <br />F,E T.yE i(G�j/dc;L� .�'+'�' <br />,vo ff/,a,es-E. B�•�o%��� <br />7J � � � � %s rsJr' <br />'�Cf.4._ <br />Approved for ConstruCtfon ate <br />—�/r-�lG.�� /- 3o-8L <br />FIN L I SPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•BB 7 5 <br />�vC24.—E PE.�'�'rT <br />Coi✓sr.c�vcr�v.r/ AT <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersi�ned owner/applicant hereby agrees to hold and save harm• <br />less the City ol Eve�ett irom any and all claims lor damages, costs, <br />expenses. or causes of action that may arise because ol installation <br />and mainlenance ef the improvement or other righbof-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Cily and to replace publi rop , ty amaged chereby. <br />�{� m� aa g� <br />5ignatu . Appli nt Date <br />WOR UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERIv11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAV B' <br />CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON P <br />PqOJECT OVER 90 DAYS DURATION. <br />