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Dated-<<' - �l <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public: Wode Permll <br />Bldg Dept, a <br />Public Works Fee $ 2� <br />Total Fee C <br />Late Appl. Fee Paid S <br />Balance Due S 261 <br />Owner Mailing Address City Zip Phone <br />J <br />Address City Zip Phone <br />Describe Proposed Work 1 LzUEL �:;L C` IIStli<D S A e� -- <br />- -- - <br />W <br />//yy <br />Project Address (if known) '"t3t% �il- Wt►15zlllC 1�iEi(: <br />-___ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />rrrrrrr� <br />• Properly Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />0:/06/90 4:03Pt'f 000AN0290 <br />0 <br />PERMIT CONDITIONS / <br />1. All calls for Inspection shall be made 24 hrs. in advance- phone 259.8810. NN nf1II11 <br />be In this and City of Everett DesiJI39Ri,�' 6lTs�rL�n,�ipn <br />2. All work shall performed accordance with permit current <br />DPT 2b 2cU.00 <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUhl BER 1-BOO- 46555.$20.00 <br />z <br />0 <br />M <br />Cl <br />0 <br />am <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 />expenses, or causes of action that may arise because of installation <br />l� 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 />AppfS d for C nstru n Date City and t lace pu Ic pr party damaged thereby. <br />FINAL INSPECTION �/ Date `!C4&fF— ' r" <br />Approved as Constructed Signature of Applicant Date <br />evengl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 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 ()"111-f PROJECT OVER 90 DAYS DURATION. <br />