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k� <br />Date U. if / / C?0 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />Public Works Permit a E)C)/` <br />Bldg. Dept <br />Public Works Fee <br />Total Fee $ <br />Less Appi. Fee Pmd $ <br />Balance Due $ I�GJ <br />City <br />c 13i041X"'../ D'- /Yla.✓rv,//e 9Soz?o 339 <br />Mailing Address City Zip Phone <br />1 ZD - 33llp-0 rnuE W <br />Attach four (4) 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 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. <br />M `rz�_I 4A; 90 <br />Approved for ConsybigHon Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />ii <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />EverEverett, WA 98201 <br />Phone: 259.8810 <br />W <br />Im <br />0 <br />M1 <br />07/18/90 10:46RM 00002679 <br />400024-179 <br />BLDG $958.00 <br />FLEG $85.00 <br />MECH ?$L8.00 O <br />FLN CH &68.25 <br />E VW%l 014.50 <br />DRVWY $20.00 <br />900027834 <br />SEWER $30.00 <br />END 11 $720.00 <br />ACKNOWLEDGAIv t& OF1tftf4.fDTIONS <br />The undersigned owner/appliM94ARWagrees to hold and save harm- <br />less the City of Everett fromWG$frond aWJ&0Jfor damages, costs. <br />expenses, or causes of actioe ma1t�q pause of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signatu6 ofAppltEant Dale <br />WORK ALL4HORIZED 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 WORT( ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />