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Date i->'� "�I <br />ApFlica�ion For <br />FUBLIC lNOiRKS I�EE�MIT <br />Print or Type Only <br />Pu�lic Work. Pcrmi� k _ <br />/ / <br />OItl9. OoPt. x � (i C.-. <br />PubllcWo�ksFeo S <br />To�al Fee <br />luss Appl. Pee Paid S <br />Balance Oue `J <br />Applicant <br />Describe Proposed Work <br />Project Address (il known) <br />Mailing Address <br />7 <br />Att2ch four (4) copies of plans for proposed work - Draw to scale antl note the following as applicabl2: <br />O Property Lines <br />• Oulline and dimensions of all existing and <br />proposed strucWres on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of street <br />• Indicate North <br />O Show any proposed grading changes <br />• Show measurements <br />BELOW THIS LINE <br />t. All calis for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All v+ork shall he performed in accordance with this permit and current City of Everett Design and Consiruction <br />♦ Standards and Specificalions. <br />3. Call Location Underground Service 4F3 hrs. before you diy. TOLL FREE N��Meert 1-800•424-5555. <br />/ t• � i /� <br />��� �/� ^ � f v / l� ^�C, �L L.[-:_( � i� � f` � / 7 �c <br />�J"'�i�L�L �% < l/ l� �4 /��G� / /... � � j7 / <br />G' '� '� ! <br />/ <br />Approved for Construction <br />FINAL INSPECTION <br />ApProved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Ced2r Street <br />Everett. WA 98207 <br />Phone:259�8815 <br />Date <br />ACfWOSVL[DGEMENT OP CONDITIONS <br />The undersignetl owneUapplicant hereby agrees �o hold and save harm- <br />Icss ihe City of Everett from any and all claims for dama�es, coyts. <br />expenses, or Causes of ac�ion �hal may arist because of instalfation <br />ar�d maintenance ol ihe improvement or other ri��ht�of��^ny use neieto <br />applied for and (urther agrees to remove samc upon no�ica from the <br />City and to replace public property damaged thmvl�y. <br />of Appiicant <br />L� <br />WCRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIIIiIfJ <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COtv1PLETION. THIS PERMIT MAY B[ <br />CANCELLED 6Y THE CITY UPON �NY STOPPAGE OF WORK ON 7liIS <br />PROJGCT OVER 90 DAYS DURATION <br />