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Date �!15/s, <br />App�iCetiun For <br />PUBLIC WORKS RERMIT <br />Print or Type Only <br />PUEbc Works Permil a <br />ema oso�.. _. Q5/15140 __ <br />Public Worhe Fee <br />Totel Fee S _ _ <br />Lasa �00� Fee PeIC S <br />Daiance Dua S <br />ttaraaret 4attson 511G 4th Avenue Sout:� t:verett 98203 <br />252-9071 <br />Owner Mailing Address City 2Ip Phone <br />Ftar Home I�p$tS}; Lnnrovement <br />i.pplicant Mailing Address <br />5319 2nd Avenue Everett 9�203 353-9278 <br />Z�P Phone <br />STAR177i�.B <br />Describe Proposetl Work �4/�i=i: ir���cJ ,T7 <;.� i�, _�E'Gr�ii �. <br />ProjectAddress(ifknown) �11( 9th 7.venue South <br />Attach four (4) copies of plans }or proposed work - Draw to a,:ale and note Ihe fol!owing as applicable: <br />• Property Lines • Centerline ot street <br />• Outline and dimensions of all existin�� and • Indicate Norih <br />proposed structures on the lot • Sh�w any proposed grading changes <br />• Existing and proposed utilities ! Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance • phone 259•8815. <br />2. All work shall be performed ir. accordance wilh ihis permit and curreM City oi Everett Design and Construction <br />Standards and Specilicalions <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�i) / /i /� <br />/ <br />l/ �C���'�i j C- Lc�'�'-��%,-`'/'-'� / �. �7 �j -- <br />Approvedfor <br />/� �` i'Ci%/ f ! - -.� j, ' �Yr'^ , �- <br />�Y -;: �- <br />Date <br />F�NAL INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Strezt <br />Everett, WA 98201 <br />Phone: 259-887 5 <br />-. �; <-_ <br />, �- /�� - <- -- <br />ACKNOWLEDGEMENT OF CONOITIONS <br />W <br />� <br />N <br />� <br />O <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />less ihe City ol Everetl irom eny and all claims lor damages, costs, <br />expenses, or causes ol action Ihat may a�ise because of installation <br />and maintenance of ihe imprr,vement or other righ�-oFway use herelo <br />applied for and further agree.� to �emove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signalure of Applican� Da�e <br />WORK AUTHOFIZED BY THIS PERMIT MUST 9E STARTEO WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEN�LY PURSUED TO COMPLETION. THIS PERAIIT PAAY BE <br />CANCELLED BY THE CITY UPON AtJY STOPPAGE OF W6RK ON THIS <br />PROJECT OVEH 90 DAYS DURA710N. <br />