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Hp� 0: <br />HZX <br />k! C] <br />H xl <br />O x O <br />'CH <br />El)H <br />H <br />z <br />OH�d�yy <br />M CO+70 <br />az H <br />t N <br />H I -a <br />q0 H <br />n i7ti <br />NIn HOIn <br />1�_ <br />'L <br />_' <br />Ll <br />F� <br />Datey�/e <br />Applic,e.cn Fcl <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permits <br />Bldg. Dept a 9G <br />Public Works Fee S <br />Total Fee <br />Less APPI Fee Paid $ <br />Balance Due S <br />AJeAL/22Z / G36 /hA4.2Sjy L.d i's2d3 3s67 <br />Owner Mailing Address City Zip Phone <br />Aye/S <br />Applicant <br />Mailing <br />Describe Proposed Work A 6 b Z77Ze., in r, <.e- • <br />Phanc <br />eflL <br />W <br />Project Address (if known) e, /hAG e. 9,e LAd Z <br />_ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />l� <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and a Indicate North <br />/ A <br />V <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />M <br />W <br />00 NOT WRITE BELOW THIS LINE <br />° <br />PERMIT CONDITIONS <br />1, All calls for inspection shall be made 24 hrsin advance - phone 259.8810. <br />City Everett Design Construction <br />2. All work shall be performed in accordance with this permit and current of and <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 11-800.424.5555. <br />° <br />(Dt: KS _Pk._V_4A-k I T �V,— i�O'A Rco <br />a, <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Gh Everett WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from ,Tny 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 />Date <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 3E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TiIS <br />PROJECT OVER 90 DAYS DURATION. <br />