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Date Public Works Permit# <br /> Appltcatton For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due $ <br /> C Lu -I"herriA) CIiurc11 0 0 a goc6re(fer rowel-7 <br /> Owner Mailing Address City Zip Phone <br /> To60I 40 Cc &iCre-tc (37((E 24' ►-k2r SC &Theft g k(i) Z. 3, 7.y1 6.-- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work AAA t", Lc, CalueV1fTe (th ( — ti1 5e.' or Ppr2 l`<l A,) ) S-772 L(. S <br /> A °N6, go O'KFPE LLEP. Cli Wei 5/DC OF -S t -- 1. <br /> MO 0 & — q P io R a 9 , /9 8 MONII-- <br /> W <br /> Project Address(if known) /k)--/D Z r�6e(&f et i e - INEE <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: f_ <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North Cn <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> al <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 in <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 0 <br /> Film <br /> • <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 /> expenses, or causes of action that may arise because of installation <br /> (kg* <br /> ,4 —\( g.- 9 g 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 /> pproved for Co truction Date City and to replace public property damaged thereby. <br /> d <br /> FINAL INSPECTION Date W ge <br /> Approved as Constructed . Signature f Appl cant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY,THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER .IS TO <br /> Everett,WA 98201 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 /> \ J PROJECT OVER 90 DAYS DURATION. <br />