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Date�-� 7 <br />---,...d,.�.o,.�= . .. . �- --- -- <br />� <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />J� <br />Owner <br />Describe Proposed Work "� f 7' � l' i! r 1 ,t j �� •,�� ,% p� <br />Project Address (if kno�vn) <br />----- - .,�-. --- - _ � <br />i <br />`�+ PuGilc Works PermitC • /� � <br />BIOp. DcOt. s ^ J�g'n �X <br />PubLc Worhs Fea <br />lolal Fee $ <br />Less qppl. Fee Paid $ i <br />Balanco0ue $_ <br />�/ 1� 3�/.� - �/ 4 <br />Z�P Phone <br />. . _ . , d5� �3 Y� <br />.�r.�.�.:f�ic.� <br />Attach four (4) copies of plans lor proposed work - Draw �o scale and note the tollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existin9 and • Indicale Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Exisling and proposed i�tililies • Show measuremenis <br />PERMIT CONDITIONS <br />' 1. All calls for inspection shall be made 24 hrs. in advance • phone 2b9•881!j, <br />_ 2. All work shall be perlormed in accordance with Ihis permit and current City ol Everetl Design and Conctruction <br />Standards and Specificalions. <br />3. Call �ocation Underground Service 48 hrs. before you di9. TOLL FREE NUMBEH 1•800-424-5555. <br />�G/3GiC <br />Lc1o,�",�c ,9F',c�h-�i /!/oi ,( �=q <br />�//�/ 7 <br />i"�,�-.-r.i <br />Approved lor Conslruction Date <br />FINAL INSPECTION Da�e <br />Approved as Consirucled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />� -tverett, WA 98201 <br />Phone: 259� $,�U� <br />W <br />� <br />� <br />� <br />r� <br />� <br />� <br />LJ <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City o1 Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance ol ihe improvement or other right�ol-way use nerelo <br />applied for and lurther agrees �o remove same upon notice from Ihe <br />Ciry and lo replace public properry damaged thereby. <br />Signature ol ApplicaM � Date i <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN ; <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br />BE DILIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF 1NORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION, I <br />_. _ ._. _ ._ . . _. . . . .____._._.i <br />