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DetR�.�/ <br />--1 <br />ApU�ication For <br />PUF3LIC WORKS PERMIT <br />Print or Type Only <br />�5�.,,J �Uoaa S �joa.l �� <br />nwner Meiling Address <br />/ <br />ln., .�1 � 1.+j,�.ea4�..aF.vY '�� <br />Appli ant Mailing Adtlress <br />Describe Proposed Work e22 � <br />Project Address (if known) �� <br />� <br />^ PuOuc Works Permit • <br />filay pao�-� � <br />PuoLc worka Fxa <br />totel Fae S <br />Less Appl Fee Pa�E S <br />BalencCUue i <br />�o . 98ao 1 33 9 �a�,-�, <br />City 2ip Phone <br />..cr. �s�. E�- y <br />Cily Zip <br />Attach four (4) copies ol plans for proposed work • Draw to scalr. and note the lollowing as applicable: <br />• Propeity Lines • Cenlerline ol street <br />• Outline a�d dimensions of all ezisting and • Intlicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Ezisting and proposed utilities • Show measuremenis <br />PERMIT CONDIilONS <br />1. All calls tor inspection shall be made 24 hrs. in advanca - phone 259•8$� 5. <br />2. All work shall be performed in acco�dance with tlns permit and current City ol Everett Desi�n and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you tlig. TOLI FREE NUMBER 1•800•424•5555. <br />�/p �U�ic 6�/a.�ES ���,i ,�'c�qv�.�".O �/P'�6 <br />�. .,�v <br />Approved �or Construclion <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agref s to hold and save harm- <br />less ihe Cl�y ol Everet� iwm any and all cldims lor damages. cosis, <br />ezpenses. or causes ot ac�ion lhat may arise because oi installation <br />and maintenance of lhe impwvemen� or other right-of-way use herelo <br />applied lor and lurther agrees to remove same upon notice irom ihe <br />Date Ciry and to replace puUlic property damaged thereby. <br />Date <br />Si�nature of Applicant Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TFIIS <br />PROJECT OVER 90 DAYS DURATION. <br />