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Date 7 �"'6—Fa Public Works Permit# �Q^ S-3 <br /> Application For Bldg.Dept.# <br /> PUBLIC WORKS PERMIT Public Works Fee <br /> Total Fee $ <br /> Less Appl.Fee Paid $ <br /> Print or Type Only Balance Due $ Na c�eix&e <br /> lei le/4 .1 40 -ge. ifil.fR 1-#4074,, /490— ii ve AVE- gicte4144. 46i00 ` ,P4 5" ` 4-1492t <br /> ..- Owner MaiHing,Address City Zip Phone <br /> -z )0pef5 c . <br /> Applicant gg Mailing Address City Zip Phone <br /> Describe Proposed Work >p Y°e t 1 7 bellooe,e0 ktcke y- of.,i 0/ '}� e. e� <br /> P <br /> W <br /> Project Address(if known) ' .25` — ��/ � <br /> ilmm <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines . • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <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 <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. z <br /> 9. .�0// "2-' tsa/J , 0(.*✓ Crtra-- e, .- '"'-- 0 <br /> Cn <br /> El" <br /> a <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 /> 7 & 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 Con uction /7/,/, Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION / Date %' � -- / ,• .=' Date <br /> Approved as Constructed Signature of Applicant <br /> / \ WORK AUTHORIZED BoY PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT • 180 DAYS OF DATE PLC IT IS ISSUED AND THEREAFTER IS TO <br /> Cedar Street <br /> e <br /> 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 /> J Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />