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i?S � e..r To c H�r;,,� <<�-�9 6 <br />Date � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�e���Wa,..o«m,�. �S 25/_ <br />0�49 Oept ♦ <br />Publ¢Wo.ksPee a <br />Total Fee <br />Lesa ADV� �ae PaiE S ` <br />Bel�nce Due t �7 OQ <br />7ia�s <br />ext. <br />Pu4et Soucd Fbw�er s Liqht Oo., Attn: T. W. ILissell �4� �� Bldg., Bellewe 454-6363 5147 <br />Owner MaiHng Atldress City Zip Phone <br />EXt. <br />Puoet mi r� T.iqh4� (y�-� Attn• T_ W_ IL755P.11 A1get POWeY Bldg.. Se11eVUE 454-6363 5147 <br />Applicant Mailing Address City Zip Phone <br />Deecrlbe Proposed Work ���t �07�tr01 HOUSe <br />Projeet Hddress pf known) <br />Aduch four (41 copies o� plens for proposeC work - Draw to scale and note the following as a4Plicable: <br />• Froperly Lines • Centerline ol street <br />• Outline end dimensions ol ell existing and • Indicate Norih <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259•887 5. <br />!. All work shell Ae pertormed In accordance with ihis permit and current City of Everett Design and Consiruction <br />Standards and Specificatlons. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•$555. <br />FINAL INSPECTION / l <br />Approved as Con;tructed v <br />everett �'UBLIC WORKS DEPARTMENT <br />� 32W Cedar Sl�eel <br />Everett, WA 98207 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undersigned o�vner/applicanl hereby agiees to holA antl save harm� <br />Iess the Cily ot Everelt from any and all claims for damages, cosis, <br />ezpenses, or causes ot aclion that may arise because ot instailation <br />�� S and maintenance oi the i vem nt or other rigM-o4way use hereto <br />applied lor and rth agrees to�move same upon notice lrom the <br />�e City and to r ace p blic propert damaged ihereby. <br />� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIIJ � <br />180 DAVS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO . <br />BE DILIGENTLV PURSUEO TO COMPLETION. THIS PERMIT �1AV BE � <br />CANCELLED BY THE CI7Y UPUN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 OAYS DURATION. <br />