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Date 6/23/83 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ownei <br />Terrv Ilammond <br />Mailing Address <br />8330 - llth Dr W <br />Mailing qddress <br />?kl <br />Everett WA 98204 <br />City Zip <br />Pu�LCWorksParmit+ �� 'J <br />Biep.Deo�.• 83/12124 <br />PUEL<WorFeFee � <br />TotelFee § � U '�� <br />N <br />Less ACP� Fee Peltl $ �U �� <br />Balarca Oue $ � � �� <br />��33/3 <br />252-6245 <br />Phone <br />353-2907 <br />Phone <br />DescribeProposedWork Cnnctr•� garage - replace existina sewer line with cast iron <br />Project Address (it known) <br />At�aCh four �d) Copies ot plan5 for gfoposed work - Draw to Scale and note ihe f011owina as aoolir.ahla� <br />• Property I_ines <br />• Outline and dimensions cf all existing and <br />proposud structures on the lof <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Cente�line of street <br />• Indicate North <br />• Show any proposed qrading changes <br />• Show measuremen�s <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Design and Conslruction <br />Standards and Specilications. ' <br />3. Call Location Underground Service 48 hrs. he(ore you dic�. TOLL FREE NUMBER 1•800•424-5555. <br />9ppr0�€d for Consiru�iion /� � D2te <br />f''�/�;�`��� ����, , . <br />� �_> -- —J `/ <br />FINAL INSPECTION Date <br />APproved as Constructed <br />eve-...: PUBLIC WORKS DEPARTMENT <br />� 3200 Gedar Streel <br />Everett WA 98201 <br />Phone:259�8815 <br />ACKNOWLEGGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_/ <br />� <br />O <br />,�w <br />_ I <br />0 <br />a <br />The under, gned ownedapplicanl hereby ayrees to hold and save harm• <br />less the Ciry ot Everett from any and all clsims for dema�es, cosls, <br />expenses, or causes ot aclion that may arise because ot installation <br />and maintenance of the improvement or other righbof�way use hereto <br />applied for and fur�her agrees to remove same upon notice from ihe <br />City and to replace public property damaged thereby. <br />��� 7- Zs-83 <br />aiyna�ur f AppliCan� Date <br />WURK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIIJ <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 STOPPqGE OF WORK ON THIS <br />PROJECT OVER �JO DAYS DURATION. <br />y F•=. I <br />� <br />y U <br />K <br />� � �"� . . <br />