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u- Works Permit . <br />`� �- <br />P, <br />.1L _ �4 / <br />Date nr,e Deer. <br />Q <br />Apptl$ation For / <br />o-E2— <br />ld Fee $ - <br />PUBLIC WORKS PERMIT P"""Toiw°'"eFee <br />Less Avol Fee Paid $ <br />O <br />0 ��^^�� rrn�? ttJ/77 pp pp pp ❑.lance Due $ Yl.F-• <br />O r^ % 11'7 .O O Lon If7 0 J <br />_ <br />Print or Type Only a <br />.Q iiO•o <br />d�o y 1 <br />Nil O w <br />sill, •o M 0J <br />O ww�CSJ <br />n <br />G!a <br />Ln n <br />&d� 6 t' Zip�one�-- <br />wner Q U d coO .r-+ C, CJ mil <br />8 n-A 18Wc�i:n p°sw <br />�0 1 � <br />a f� t <br />nt CMS, i Failing Address City Zip Phone <br />/V Applicant <br />Applicant <br />Work T <br />Describe Proposed <br />--- <br />W <br />Project Address (it known) <br />1� <br />Attach tour (4) copies of plans for proposed work - Diaw to scale and note the following as applicable: <br />• Centerline of street <br />• Property Lines <br />• Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Shuw measurements <br />• Existing and propo=ed utilities <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />be made 24 hrs. in advance- phone 259.8810. <br />1. All calls for inspection shall <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 />Underground Service 48 hrs. before you dig. TOLL FREE/NUMBER 1.800-424.5555. <br />3. Call Location <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the oof Everett from any 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-ol-way use hereto <br />applied for and r agrees to rdemgve same upon notice from the <br />ed C u lion / Date City and to re a public prop ty da/naged thereby. <br />FINAL INSPECTION Date le <br />ignatur Applidant <br />Approved as Constructed <br />WORK A THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />320C Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8810 PROJECT OVER 90 DAYS DURATION. <br />