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Date_/_E �8 <br />Application Fur <br />PUBLIC WORKS PERMIT <br />Print or Tvpe Only <br />�Sr Owner N(M VDU <br />Owner Mailing <br />Describe Proposed lyork <br />Project Address (if knowr) <br />Publa: work, Permits <br />Bldg, Dept ♦ _ <br />1¢ Works Fee <br />Total Fee $ <br />LLess Appl. Fee Peed S _ <br />Balance Due s <br />47Z <br />pram <br />— I ruur.e <br />Attach four (4) copies of pl lns for proposed work . Draw to scale and note the following as applicable- <br />0 Property Line. • Centerline of street <br />• Outline and ]. onsions of all existing and • Indicate North <br />Proposed structures on the lot • Snow an <br />• Existing and proposed utilities Y Proposed grading changes <br />• Show measurements <br />X <br />s <br />w rvV i vvnll lZ url_UW I11I5 LINE <br />FERMI I- CONDITIONS <br />1. All calls for inspection shall be made 24 his, in advance - prone. 259.881 O. <br />2. All work shall be performed in accordance with this permit at d ,;urrent City of Everett Design and Construction <br />Standards and Specifications. <br />33.Call Location Underground Service 48 firs. before you dig. TOLL FREE NUM13EER 1-800-4424.5555. <br />N/>crrectla/� v �E r .la� i � oYta��iai 7 iV7. <br />FINAL INSPEGTTION <br />Approved as Constructed <br />evrrett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259-8810 <br />CC(Aef. Cc c j ti r a rn <br />/" r <br />12/13/88 11:1zAM 0001193738 <br />O000614639 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold ano save harm. <br />less the City of Everett from any and all clains for damage.:, 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 :'move same upon notice flour the <br />City and toreplace public propeity damaged thc--reby. <br />IN �� — /- <br />Si at re of ARphwnt Date <br />W R AUTHORIZED BY ?HIS PERMIT MUST BE STARTED WITHIN <br />180'AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PLRMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />