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tigF a i( 4 u: 'i�' "'�as .z^F ^1;r�t, <br /> Date Public Works Permit# <br /> Application For Bldg.Dept.#. <br /> PUBLIC WORKS PERMIT Public <br /> Works FeeTotal e $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due $ <br /> /Z2/4 6>4.SL4/. x// 1,• "'/, ( W u�' 2/ !/C,tfr Yt K -U/ <br /> Owner Mailing Address City Zip ! Phone <br /> ,�T - /�t/c t , a1 / /�L / 1 ?, S 4 1 I/L-1Z,t- ff °3- ' 2--1,eL 7 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _-F--(— -T---73‘4 CT, I i i ' r l ! L^ g f .c �; <br /> U r 6 F / 0 <br /> �J / �, W <br /> Project Address(if known) 2.� 4' " 'o ? Zf liii,_ i/Jim" <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: mom <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CD <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <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.TOLL FREE NUMBER 1-800-424-5555. z <br /> A <br /> • <br /> / qi <br /> jCtif-e-'61-1)1"3 0--)t- '-'24-1,6YZ;i: ce---ve• /t/-6---c c. i dt4t-iiit ,l, <br /> fii 0 <br /> Elm <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> } less the City of Everett from any and all claims for damages, costs, <br /> r / expenses, or causes of action that may arise because of installation <br /> -;:k Ott 4-)( ,' 0/ and maintenance of the improvement or other right-of-way use hereto <br /> A(�proved forCo�is ructioni ( Date applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> f /J <br /> FINAL INSPECTION Date Y Ytt� L1 >ft i., t / <br /> Approved as Constructed Yfo 'ignature of Applicant / "Date <br /> everetce PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 <br /> Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />