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DateAY Public Works Permr a <br />Application For Bldg Door • <br />7 (p <br />PUBLIC WORKS PERMIT Public WorksFee <br />Total Fee <br />/ <br />Less Fee Paid $ <br />Print or Type Only Balancece Due $ <br />►yk14 - Ttttl 6 9L1. 6o' s. Ow-t-.�,el. FU: <br />Owner Mailing Address City IZip Phone <br />lc <br />rt <br />Applicant Mailing Ad, ass City Zip Phone <br />/ <br />Describe Proposed Work I VlYLr2y yUzngVILW !Zt X 4i%f t,( me; 4a, ,sr,,V % <br />yf, vief, <br />baSwN� ( ti�cv n Ce, Frr rn��l+b rlt� (G tat <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work -Draw to scale and note the following as applicable: <br />• Property 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 />PERMIT CONDITIONS <br />O <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be performed in accordance with this City <br />permit and current of Everett Design and Construction <br />Standards and Specifications. <br />Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />.r,33.. <br />L�✓0/f%` die, <br />�c�lY�'!/�43 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 />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon noticB from the <br />App ved for nsir wn Date <br />y �- City and to replace public property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />Signature of ant / / Date <br />WORK AUT RI ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />