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L_ '2-2�-5 <br />Date� 1J 0/90 <br />ApPlication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Steven Sartlow <br />TO POSTING ��"`��� <br />3711 — 122nd Pl SS Everntt 98204 <br />MaAing <br />c�ry z�� <br />PumncWo�wxrcrmn. ��/3�'�' <br />ema oco�� • 90/25095 <br />ruei¢Y,'o�ksPoo $ <br />To�al Fec <br />�es: A00�- Fee Pa�d � <br />Dalance0ue $ Z-'� <br />337-9079 <br />�ner <br />Applicant Mailinq Address Cily Zip Phone <br />Describe Proposed Work <br />Proiect Address Iif known� <br />Atlach lour (4) copies ol plans for proposed wo�k � Oraw to scale and note Ihe following as applicabl�: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all enisting and • Indicate Nor�h <br />proposed siruclures on the lot • Show any proposed �jrading changes <br />• Exisling and proposed utilities • Show measurements <br />LIN <br />PERMIT CONDITIONS <br />1. All calls tor inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with Ihis permil and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you diq. TOLL FREE NUMBER 1•800•42Q•5555. <br />i-�,�� ��,i��� �-Z4-� <br />Appr j lor Construction Date <br />/ / .. �i�J� <br />� '-" �"` Gf�`�kKa`c�� °?�/�/�'/ <br />F'iNAIINSPECTION L� � Date <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EveretL WA 98201 <br />Phone:259�8870 <br />ACKNOWLEDGEMENT OP CONDITIONS <br />W <br />H <br />� <br />N <br />�w <br />_r <br />O <br />a <br />The undeis�gned owner/applicanl hereby agrees to hold and save harm- <br />Ir,ss the Ciry of Everet� Irom any and all claims for damages, costs. <br />expenses, or causes ol action Ihat may arise because ol installation <br />and maintenance of ihe improvement or other right�ol�way use herelo <br />applied lor and lurther agrees to remove same upon notice irom the <br />Ciry and to replace public property damaged ihereby. <br />G�--`_%� ��' - <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENiLY PUFSU[D TO COMPLETION. THIS PERIdiT �1AY BE <br />CANC[LLED BY THH CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION. <br />