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Date712SAR3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Worke Permit a <br />edg. Der <br />Public Worxe Fee <br />Total Fee S <br />Less Apiel Fee Paid S <br />balance Due S <br />SNOHOMISH COUNTY 3000 Rockefeller EyeraLt-_i 259-9488 _ <br />Owner Mailing Address City Zip Phone <br />Same <br />Applicant Mailing Address City Zlp Phone <br />Describe Proposed Work rrinatruct Cnnhnmi ch fnit4ty Ratantin Far i1 ity <br />Project Address (if known) 2e-- /t,1AL < <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <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 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 />r 1 •� t� (�la Z.S T Ct csre czVt, roX.•c.: ..c1 I\y/ri/K3 <br />r � <br />S. Rcid.T,o.\(:.I �,�e.-....11. (,,.,1/cr e'..rb re(�Inr�...o..•1- ,,.\r..1 be <br />W <br />tip <br />0 <br />z <br />0 <br />0 <br />an <br />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, �causes of action that may arise because of installation and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice Irma the <br />Wo ed for Construction Bate City and to replace public property damaged thereby. <br />INAL INSPECTION ../ Dete <br />Approved as Constructed Signature of Applicant Date <br />everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Ltreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />i <br />Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. <br />