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Dated 1 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Describe Proposed Work <br />Project Address (if knnwn) <br />S �C.�.l•54bef�,. flbl-35�. <br />Mai{ing Address <br />Ov-L,. <br />Mailing Address <br />��i-=-�i Q l- L i �+ , a�—� <br />„E-,_.. i�Al�+� �. � <br />Puolic works P�. .nn • / G• � � <br />ame. oeai. + <br />Puhlic Wo�Ns Fee $ <br />iotal Fea <br />Less ApO� Fee Paid $ <br />�0 <br />BalanceDuo $ z0 <br />Oo2-322-'10-000-/8 - 83/ <br />�� � �sz-2S08' <br />up rnone <br />Attach four (4) copies of plans for proposed work - Draw to scaZe and note the following as applicable: <br />• Proparty Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures onthelot • Show any proposed grading changes <br />e Existing and proposed utilities � Show measurements <br />G <br />PERMITCONDITIONS <br />1. All cnlls 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 />y, �-� �,�, �.�, <br />S. T/,� �u�,.,,� .�e �'m. <br />� �'(' c/� �� ° <br />FINAL INSPEGTION <br />Approved as Constructed <br />�A�I�PUBLIC WOflKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8810 <br />�LPa.u�..�,..� � 9 n�or� len�. � ,c�ru�..� <br />�6/�b/41 <br />/ <br />N00053U40 <br />DFT.20 <br />CHEC4; <br />�'24FM OODRN7b05 <br />9�0.00 <br />820.00 <br />W <br />F- <br />� <br />� <br />O� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims for damages, costs, <br />expenses, or causes ot action that may arise hecause of installation <br />and mainlenance of the improvemenl or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice trom ihe <br />City and lo replace publir, property damaged ihereby. <br />�� �,�,�-L,.�iC��-�----_ G�Lt�4� <br />Date <br />Signature of Applicant -� �ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />B[ pILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON AN\' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />