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TYPE OR PRINT ONLY <br />Owner <br />Application For <br />PUBLIC WORKS PERMIT <br />Describe Proposed Wark <br />PUBIJC'N7RKS DEPARTMENT <br />3200 Cedar:)treet <br />Everett, WA 98201 259-8810 <br />Mailing <br />Adtli�ss <br />City <br />tti <br />u�'z q s s<,l <br />Date � � I � 1 v <br />PublicWorksPertnitM�Z9b' ---. <br />Bui!ding Permit F <br />O <br />Public Works Fee $ �Qy� <br />!�/lF� �%e�� � <br />Zip <br />zp�/as•�s�'°'�696 - <br />PROJECT ADDRESS �if known) �7 �� �C �2/iq/+� UENC EUYQtff %N� Q� <br />Attach four (4) copies of plans lor pmposed work - Draw to scale and note the following i1 applicable: <br />•Property Lines 'Outline and dimensions of all existin9 and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of streot •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection sliall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Locaticn Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />T. Th sfQ � L frcr [T, C. C.o h f.ro L <br />�ar C��/ S��cHo�4n G� i�L4v� <br />S R2S70/"r QI-24 %O OYiq�i,�.L <br />c./ <br />D,� P�.�. Tir.aFf'� � <br />,v�.�- �,:�-2 -9a <br />FINAL INSPECTION Date <br />Approved as Constructed <br />0 <br />pCa n <br />%O/ B 02 70/.q <br />Coh a� �iov. DiC E4UAL„ <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City ol Everett irom any and all clalms for damages, costs, expanses, w <br />causes of action that may arise because of installatiun and meintenance ot <br />the improvement or other right-of-way use hereto applied for and tuAher agrees <br />to remove same upon notice from the CNy and t piace public property <br />damaged thereby. <br />WOHK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT �S ISSUED AND jI�REAFfER�IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS PROJEI.T OVER 90 DAYS DURATION. <br />