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Date -� — L� —G� v <br />Application For <br />PUBLIC WORKS PERMIT <br />�cs! D�=7.l�.0 <br />Print or Type Oniy ��, �� � �� s�' <br />Cwner <br />.—� <br />� � � o 1��� �C '� .� <br />Mailing Address Ci <br />ifjC� ✓C <br />MBIIIng Atltlfe55 <br />� <br />� <br />Puobc Worxs Permit + � ` /�� <br />Bldg. Deo�. • <br />Publ.c Works Fee <br />Totai Fee $ <br />LA55 AOOI FB9 Pam S q <br />BalanceDue $ �`0 ��O <br />���Y ZiP Phone <br />� /� N 171 �/t W F�\/ � <br />Describe Proposed Work Tr� 'r �C� �� i i� c -C C. E�SS -Z% c�ni � <br />Projec� Address (if known) �� �-' �' <br />Attach (our �4) copies of plans for proposed work - Draw to scale and note the fe:lowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed 9rading changes <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 peAormed in accordance with this permit and aurent City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you diy. TOLL FREE NUMBER 1•800-424-5555. <br />/v <br />� �'n�s'�D <br />�g��£u-n4 <br />�qvfN� <br />� � r� w <br />I'2ao�'-zi- � <br />� <br />z � 5 t s-r. <br />�ir/GLC� �i �= '3.L � %� 0 <br />Ayproved tor Ccnstruc ' n ' Date <br />l�`� �/�-i u <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everelt, WA 98201 <br />Phone:259�8810 <br />03/27/90 5:47F'H OOORH0706 <br />/ <br />H0003.�215 <br />DRUWS' �20.00 <br />CHcCf; 420.00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />! <br />� <br />Zi <br />O� <br />♦�A <br />�Y <br />O <br />a <br />The undersigned owner/anplicant hereby agrees!o hold and save harm- <br />less the Ci�y ol Everelt Irom any and all claims tor dama�es, costs. <br />expenses, or causes of o�tion that may ari5e because of installation <br />and maintenance of ihe impruvemenl or o�her righ�-of-way use hereto <br />applied lor and lurther agree.: lo remove same upon notice from �he <br />Cily and to r place p blic prop y dama d thereby. <br />�/ � <br />O <br />Signature ol Applicant Date <br />WORK AUTHORI2ED BY THI RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMI S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAY B[ <br />CAfJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />