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Date -�9-88 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />-U,elo-z,�_ fi.'e�� . �. �a. e3oX ; <br />Owner Mailing Address <br />� <br />� <br />� <br />Puol¢ wo�ka Permit . —S7 � �•J �� <br />eiea-oeo�.� . <br />auouc Worhs Fce <br />Totsl Fee S <br />Lass Roo�. F¢¢ PeiE � <br />Balance Due $ �0 � <br />�s2-3o9 <br />Applicant Mailing Atldress Cily Zip Phone <br />Describe P�oposed Work CO.vS7i:l.�GT /1�.�G/ �% �--.t�. <br />Project Address (if known) <br />Attach four (4) copies o1 plans for proposed work • Draw to scale and nole the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing �nd <br />proposed structures on lhe lot <br />• Existing and procoseA utilities <br />• Centerline ot street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show mea::urements <br />PERMIT COND�TIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. Alt work shell be performed in eccordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•�24•5555. <br />G'��' �� P��ew ��/� � ��.,�, ���0�'` � <br />.�c�cu �e�,�...�..� Cvo-r� �.- `��.,cE�'ce dP,.�l. �.e�� <br />S-teL'�i S.¢eexiri e'o�c,.cep�`�.,� - <br />- �iobf� � /`l r39 <br />Approved for Cons ion Date <br />1��� /v-// <br />FINAL INSPECTION Date <br />Approved as !;onslructed <br />evere[t PUBLIC�VORKSDEPARTMENT <br />� 3200CedarStreet <br />Everet6 WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applican� hereby agrees to hold and save harm• <br />less the City ol Everett Irom any and all claims for damages, costs, <br />expenses, or wuses ol action that may arise because ol installation <br />and maiMenance ol the improvemen� or other rigM-ol�way use he�eto <br />applied fo� and further agrees to remove same upon nohw irom the <br />Gity and lo replace public property damaged thereby. <br />. � .�oo.'.� H_ C-3a-r�-�a -21-$`� <br />Signature ol Applicant Dale <br />WOAK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br />B[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT JVER 90 DAYS DURATION. <br />