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Date Public Works Permit # 08 <br />Bldg. Dept. # <br />IM Application For <br />P U B L I f WORKS PERMIT Pub TotalFal Fes Fee *e*�s <br />ee $ <br />;.� Less Appl. Fee Paid $ <br />!- Balance Due $ e3e3A <br />Print or Type Only <br />�/ [. V i 270(/IA�ci fi6, 1 !f , r �f ! �Z )o7 '! %Cri <br />Owner a Md ing Address City Zip Phone <br />) <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work L nq e, s / <br />l <br />W <br />Project Address (if known) /V � 41e <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <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 <br />' DO NOT WRITE BELOW THIS LINE <br />' PERMIT CONDITIONS O <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 />4 w A T' L ' ' ' 6 . z <br />1A ,71 ry CIO") <br />'a� O <br />a <br />()JA <br />Approved for Construction <br />1 — <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />J&Z77PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <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 />applied for and further agrees to remove same upon notice from the <br />City and xd—re�iace public property dz aged thereby. <br />Sig aVre of Applicant Date <br />WORK AUTHORIZED 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 WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />