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<br /> Public Works Permit# �
<br /> - Application For Bldg.Dept.#
<br /> PUB IC WORKS PERMIT PubTcWorksFee
<br /> otFee $Less Appl.Fee Paid $ / +
<br /> Print or Type Only 'l a Balance Due $ , ••• ..�'
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<br /> Owner . t1C Mailing Address City Zip Phone r )
<br /> Applicant Mailing Address City Zip Phone
<br /> Describe Proposed Work 11-A A'-- G P-I,►1,` .. -' 'e'' , s"'''',"'"Wel# ,-
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<br /> Project Address(if known) .� Q E'"� /-- .k'" ,/'/." X i "f�F' `� , :
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<br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: moo
<br /> • Property Lines • Centerline of street
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<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
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<br /> DO NOT WRITE BELOW THIS LINE
<br /> PERMIT CONDITIONS Q
<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.
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<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 /> and maintenance of the improvement or other right-of-way use hereto
<br /> AP .r / �. applied for and further agrees to remove same upon notice from the
<br /> Ap. ove- or Cons uction •ate City and to replace public property damaged thereby.
<br /> FINAL INSPECTION Date 6417--es . 0 1/
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<br /> Approved as Constructed Signature of Applicant Date
<br /> 1 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN
<br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> git 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE
<br /> Everetttt,,WA WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS
<br /> J Phone:259-8810 PROJECT OVER 90 DAYS DURATION.
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