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H 0r H <br />Nh71�1 <br />!D pd x <br />C H <br />�Hrn <br />F<< CH] <br />H '�1 <br />H 'i1 <br />to HH-+, <br />ITJ O r+7 <br />H t7 <br />O H �J <br />H t=1 O <br />H V C' <br />H r. <br />2 H F <br />z� <br />HH <br />co H <br />n ty Co <br />Mo H O1:13 <br />' 1 <br />U <br />_ <br />L 1/ <br />11 <br />1st <br />00 <br />1 <br />Date tii Par <br />Bldg D.PL . <br />Applicahu -For Biap. Depr. •. <br />Tcui Feeiee S <br />PUBLIC WORKS PERMIT Pdplic Work, <br />Less Appi Fee Peed S <br />Balance Dud 5 <br />Print or Type Only <br />ill,lp m �� 7 y <br />)t 1�t A <br />I-QvInner Mailing Address City Zip Phone <br />Applicant Mailing Address Ciity� Zip Phone <br />Describe Proposed Work��-- <br />W <br />r Address lit known) <br />eject <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following :. applicable: <br />f Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />vj <br />proposed structures on the lot • Show any proposed grading changes <br />s Existing and proposed utilities • Show measurements <br />W� <br />�— DOO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall bo 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. <br />z <br />0 <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett WA 98201 <br />Phone:i59-B810 <br />cn <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ct Everett from any and all claims for damages. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance o' the improvement or other right-ot-way use hereto <br />applied for and furthar agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST SL STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />EE DILIGENTLY PURSUED TO COMPLcTION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY S10PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />