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Yam. > • b: 10 '40, 4;wv.. -4,44` `l '�'r tw- ,,,•,-,,.4•*41r'i a, ,-T -.�3} .343`*4:;= <br /> Date 7 -6-Td Public Works Permit# 7' 3 '3 <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Balance Due $ NO C/V?Q'&47' <br /> Print or Type Only <br /> 'O'Owner MaiEing.Address City Zip Phone <br /> Applicant Mailing Address/ City Zip // Phone <br /> Describe Proposed Work k'i i 1i►o+ b It Att ekes''" 1 C�//� Yip e e,�r <br /> V <br /> 474 <br /> .s <br /> w <br /> Project Address(if known) l 2 ) 7 -- .7�'2/ v r✓' Illimi <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: mom <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North CO <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> Ca <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS 0 <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction oil <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> o <br /> 0 <br /> a <br /> milowl <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, or causes of action that may arise because of installation <br /> 70 and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Appr ved fo on uction Date City and to replace public property damaggred thereby. <br /> w.. - <br /> FINAL INSPECTION Date <br /> Approved as Construct d Signature of Applicant �. Date <br /> / \ WORK AUTHORIZED B 'f PERMIT MUST'BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE IT IS ISSUED AND THEREAFTER IS TO <br /> e3200 Cedar Street 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 /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />