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�,.�..�....�.. . � . . - <br />�4. , <br />� � . . , C� Appllcatbc Por <br />`- PUBLIC WORKS PERMIT <br />TYPE OR PRINT ONLY <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257•8810 <br />� <br />Dale <br />Public Works Permil a <br />4-12-99 <br />Building Pertnil8 62142 <br />Public Works Fee S <br />David Epperson 2023 Virginia Ave Evezett 98201 425-303-0186 <br />Owner MailingAddress Ciry Zip Phone <br />Ownet <br />Applicant Ma"��ng Address City Zip Phone <br />Describe Proposed Work <br />new detnched <br />PROJECTADDRESS (if known) <br />Ave <br />Attach four (4) copies plans for proposed work • Draw to scale and nole the lollowing if applicable: <br />• Property lines • Outline and dimensions ol all existing antl proposetl struclures on the lot • Existing and proposed utilities <br />• Centedine of street • li Wicate North • Show aqy' proposed gretling changes • Show measurements <br />DO NOT WRITE BELOW THIS <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be periormed in accordance with this permit and current City o� Everett Design and <br />Construction Standards and Specifications. _ <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Nof,e: ��c�C Sew�r � Itw�E�o,� �GYM,t rt8�;rad,�� <br />, ��y�+ <br />�C�ue��r� of Gca,v✓� S�u{ r-f-�. ��, <br />� r-� 7� C�o,nrl 6�� �vu/✓1 S��uJ-ES `�-9 S;��e s`e�/P�i. <br />ppmve or ons mc ion a e <br />FINAL INSPECTION <br />Approvetl as Constructed <br />Date <br />ACKNOWLEDGEMENT OF COND�TIONS <br />The undersigned owner/applicant hereby agrees to hold anC seve hartnless <br />the Ciry of Everen trom any and all claims lor Oamages, costs, eKpenses, or <br />causes ol actior thet may arise because ol installation and maintenance of Me <br />improvement or other �ghtof�way use hereto appiied for end tunher agrees to <br />rer,�ove same upon no�ice irom the City and to replace publk property tlam- <br />aged thereby. <br />igna ure o pp ican a e <br />WORK AUT}10Fi�D BY 7HIS PERMR MUST BE STARTfD'�NfTHIN 100 DAYS O: DAIE PERMR IS ISSUED AND hEFiEAFTER IS TO BE qLN'aEMLY PURSUED Tt� <br />OOMPLEf10N. hilS PERMfT M4Y BE CANCELLED BY 1HE CtTY UPON AfJY STOPPAGE OF VJOPo( ON 7HI5 PRQIECTOVER 90 DAYS WRATION. <br />