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Dateii=(z.l (Cl °.our. w.n. Perm <br />Application For aide o.or <br />PUBLIC WORKS PERMIT °°°:o, Fork <br />„Fee <br />TO POSTINGxo••AM-F.. Pud$ <br />Print or Type Only <br />--r�.,-T -rat-,m�r� � min / .5/S� ✓�l�' /lam 9F>�7� �o59-�a� <br />Applicant Melling Ad,(drro-,s City Zip Phone <br />Describe Proposed Work <br />90002397L <br />Project Address (if known) 10922— " TTHAVE 5EJ R6RG—RED.I <br />Attach four (4f copies of plans for proposed work - Draw to scale and note the following as applicable: MECH $60.00 <br />if Property Lines • Centerlme of street PLN CH $8.77 <br />• Outline and dimensions of all existing and • Indicate North B SRCH $6.50 <br />proposed structures on the lot • Show any proposed graf iC itiji nges 420.00 <br />• Existing and proposed utilities • Show measurements 000006707 <br />..., ..,. .....-- ----- ..._..... 000027700 <br />PERMIT CONDITIONS SEWER $30.00 <br />I. Al l calls for inspection shall be made 24 her. in advance -phone 259.8810. 1171-5 S949.00 <br />2. All work shall be performed in accordance with INS permit and currant City of Everett DesigEjff1qqonstW�.r00 <br />Standards and Speclliwllons. yFp <br />3. Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1.800-4Z4'-1555F777.27 <br />-4. 5I LT FCNGE 511ALL- �E IN7TAL-LCT) Air r IltOWN cN <br />SITU Pvat-A ANq ft1:L c 1-rY ST++N9rtep Z�S. <br />�QILQ IMc-Kna a/z.1. <br />cti A r d for C uon a� le <br />FINAL SP TION to <br />Approved as Constructed <br />i <br />rett PUBLIC WORKS DEPARTMENT <br />E200 verett A Sheet <br />Everett, WA 98201 <br />Phone: 259 0810 <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 />end 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 damaeed thereby. <br />Signal r of pp scant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />130 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 />