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APPnwtion For <br />4aff PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />TYPE OR PRINT ONLY 7ING <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />City <br />Date <br />Public Works Permit #� <br />Building Permit <br />Public Works Fee S 3-J QVy — <br />.4,� <br />Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />°Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: 10. <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8 ty <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4, �nSf�C� CL Jr47�6' 1017-1 <br />f� �7rC✓G^f l�Jt1S/n-_r ' f-i/-, <br />Approved for uonslruTfi Date <br />C <br />U/ /^4!�( �A7 19S 9:33AM 1 <br />7'a «1�y 4-2 - / <br />#00051825 <br />BLDG $204.00 <br />SRCHRG $4.50 <br />DRIVWY 435.00 <br />CHEW $243.50 <br />Vi <br />ca <br />O <br />M2 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />FINAL INSPECTION /Date f� <br />Approved as Constructed �� <br />Signat of Applicant Date <br />AUTHORIZEDWORK BY THIS PERMIT MUST <br />COMPLETION.H SERMIT MAY BE STATED <br />CITYIUPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. UIR TION. PURSUED TO <br />