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Date 7 ""6—F® Public Works Permit# /09,e," 373 <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 $ Ala OWo-de <br /> - <br /> Print el-I / 4 %tee vu e.ai Par 7 —Rat <br /> Owner MaRing.Address City Zip Phone <br /> Applicant Mailing Address/_ City Zip Phone <br /> Describe Proposed Work 0 kQa i A it ode d 'een x.c ete- o� o//ecr 74, de. �4^ <br /> WI <br /> Project Address(if known) 111. .7-g*i 7 e ' Fill <br /> - <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 Cn <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/# /.9,701.,,,, "3-7-e---64-2.-a e--4.7 271.'?‘ 0 <br /> pe w (1.-.—E. i9.-'-'- . fi <br /> FM. <br /> CO <br /> 0 <br /> OM <br /> Arninimmo <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 /> jc 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 7ttuction / Date City and to replace public property damaged thereby. <br /> -- <br /> FINAL INSPECTION Date - �� �� . --- ����"='"� -5-®''7/-"fo <br /> Approved as Constructed Signature o`f Applicant '�� Date <br /> evereti PUBLIC WORKS DEPARTMENT WORK AUTHORIZED B)'TS PERMIT MUST BE STARTED WITHIN <br /> 3200 KS 180 DAYS OF DATE d IT IS ISSUED AND THEREAFTER IS TO <br /> e Everett,00 Cedar 9 Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: W01 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> \ / PROJECT OVER 90 DAYS DURATION. <br />