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H rOrH <br />,O H <br />C <br />H to <br />0=0 <br />VHhd <br />N H <br />H <br />�ci <br />HL7 <br />Hag <br />Q. o <br />H <br />Z H <br />C:) <br />1 SAW <br />Date -` o Publ.W.,wPe,me. 90— 503 <br />, . <br />Application For BldgDepta <br />PUBLIC WORKS PERMIT Pubrorole w°FeeP°° — <br />e $ <br />Less spill. Fee Paid $ <br />Print or Type Only TO POSTING I <br />��10�gv Balance Due $ <br />2c2rn1�- <br />/�.� <br />Project Address (if known) <br />Attach four 14) 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 his. 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. <br />j tz4 evort /P de done /der ,olan Qp�1ro.�ol <br />//) fhe 6'/y Pclhll' wo.-Ar dept asp 12-6--90 <br />o�',4y S-I ea2Fs ilre �o la /(eyor CC��n 2f <br />sales, AW <br />1p, Cvnfrareytor �a ConSfrue7c fQ/„Pora^f Constcaafvn <br />GA11irance ,?s reglvi/"eo/ flier C t'XySfand4rc✓ Oad,9 <br />Approved f Construcli h' yDate <br />FINALIN Date <br />Approved as Constructed <br />I i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everele tt, WA 98201 <br />Phone: 259.8810 <br />UJ <br />0 <br />''Fm^ <br />V♦ <br />0 <br />IL <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees 1.. hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action Ifyit may arise because of installation <br />and maintenance of the Im rov ant or other right-of-way use hereto <br />applied for and further re silremove same upon notice from the <br />City and to tulace wg 6Mly damagec�hereby. <br />,Signature of Applicant 'y uare <br />WORK O HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />4 <br />