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Date 7 � ��-5 <br />Apalication Foi <br />PUB�IC �i/C►RK� PERMIT <br />Print or Type Only <br />C� <br />Ovmer <br />Applicant <br />Gescribe Proposed Work <br />Mailing <br />S <br />Prujec[ Address (if known) � _ <br />City <br />City <br />Attach four (4) r,opies of plans tor proposed work - Draw to scale and note the followiny as applicable: <br />• Proper�y Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Ezishng and proposed utilities <br />PEHMIT COM1DITIONS <br />� <br />Puallc WOMS Permi� a��- �7/ �� ` �� � _ <br />BItlg.Oept. r 2L_]_� I�S <br />.. �-� , <br />Public Nbrks Fee <br />Tatal Fce 5 <br />less AOGI. Fee Paid $ J� <br />Balarco0ue u ��'��/ <br />• Centerline of sUeet <br />• Indicala North <br />• Show any proposed grading changes <br />• Show measurements <br />NE <br />Phone <br />1. All calls for insFection shal! be made 24 hrs. in aCvance - phone 259•$81 5. <br />2. All v�ork shall be performed in accordance with this permit and current City ot Everett Design and Construction <br />Slandards and Specificaliuns. <br />3. Call Loc2tion Underground Service 48 hrs. before you d:g. TOLL FREE YUMBER 1•800•424-5555. <br />5! C�.sF <br />for <br />��-�T��-.�s .?�� ,�r�t�.ay c��,- <br />FINAL INSPcCTIOtJ ' \ � <br />Appreved as Constructed v <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everel(, WA 98201 <br />Phone: 259�8875 <br />P.CKKOWLEDGEMENT OF CO�CITIONS <br />• <br />The widersiqned ownedapplicant hereby agrees to hold and save h:vm- <br />— less �he City of Everett trom any and all cl�ims for damages, cusis, <br />expenses, or causes ot action Ihat may arise ber,euse ol installation <br />-� � and maintenance of �he improvement or other ught-ol-way use hereto <br />—/d` —c7S appliai (or.^�,�d further agrees to remove szris u�on notice from the <br />Date City ;nd lo replace public property Uamayc�.: ..�,�a..y. <br />��-,- �/� � 7/is/�s- <br />Signatura of Applic t � Dete <br />WORK P,UTHORI�D 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF �ATS PERMIT IS !SSUED AND THEREAFTER IS TO <br />BE DILiGENTLY PVRS�IED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />