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Date��Y/_ <br />Public Works Permit # i1 .22V <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Bldg. Dept. # <br />Public Works Fee <br />Total Fee $ <br />Less Appl. Fee Paid $ <br />Balance Due $ <br />V3 <br />pD Z --222 - 310. 0.V D - /g -- 8 3 / <br />Owner Mailing Address CityZip Phone <br />A'ppli'cant Mailing Address City Zip Phone <br />Describe Proposed Work F ! LL r M 13AC'Ky�-AL ;1-0 0 — 300 CUR 1 C VA" S_ <br />Project Address (if known) <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 />E <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 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 />I�do✓ T i�C /0S'6i �S C O�e S 7` f�� c . off' (/a <br />5 Seeo/ s4peS 4s Soo h as /0" ss, 6Ce <br />`'/e w rn r f e j-1 a L <br />101-0 (GAG / 7`r�eS 4s /fii UC/ IS .00 S-/6le 06/21/91 2'41PM 00007535 <br />/ <br />7 Da riot j�lace PLC ih w�fLand �uf�^ 4r�f30[15.?Ofs6 <br />DPTe20 $4-3a50 <br />CHECK: $43 0 50 <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />CLPUBLIC 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 to replace public property damaged thereby. <br />Signature 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 />