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_ Date—_ � //V ��F �.V� <br />P � i or <br />PUBL.iC WORKS PERMIT <br />Print or Type Only <br />�y <br />� <br />i- n.�—„ <br />Owner <br />�. �l� �,t : <br />ib1 tiiing qCdress <br />���v � 7_�r. <br />Publq YlorMs Peimil • <br />BI�9. �e01. � __ <br />Pu�hc Works Fee <br />Toiai cee S <br />Less 4ppl. Fee PaiC $ <br />Balante Duc S <br />Applicant Ms�hn;; Address C�tv Zip Phonc <br />Projecl Address �if knok•n; <br />AttaCh t0ur (4) Copies o� pl�ns for uroposed wurK - Drav: to scai.x ann ncte u�a !o�luwing as applir.ahle: <br />• Property Lines <br />• Outline and dimensions ol ali existing and <br />proposed structures on Ihe lot <br />• Exis�ing and pioposed utilities <br />Approved �or <br />• Crnterline of street <br />• Indicate Nerth <br />• 5hew any r,ro�osed grading changes <br />• Show measur>ments <br />ut� rvU� wniit tltLUW THIS LINE -- <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advanr,e - phone 259-8810. <br />2. All work shall be pedormed in acwrdance with this ?ermit and current City of Everett Design and Consiruction <br />Standards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER i•800•424-5555. <br />��. y��- <br />�� � <br />f�v� ��"►�`w► <br />! N � S? <br />���' e�' d" � <br />I l�^ <br />�' � �� .� <br />����i �,�, �' , G�-3'� <br />��� � <br />Dale <br />FI�AL INSPECTION Date <br />Apuroved as Constructed <br />�FUBLIc' WORKS DEPARTMENT <br />�j 3200 Cedar Street <br />��T Everett, WA 58201 <br />Phone:259-881C <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />0 <br />H <br />� <br />0 <br />a <br />Tho undersianed owner/applicznt hereby agre=s to hold and save harm� <br />less ;he GIy of Everett fwm any and all c;a'ms for tlamages cosls. <br />expenses. or causes of action that may anse because of installation <br />and rnaintenance o! ihe improvement or other right-ot-way use hereto <br />appi�eA Ipr and luriher agrees to remove same upon notice from the <br />C���to rePlace Pubh ar Perty damaged thereby. <br />(��-Z7-9 <br />Signatur ol ppl can! DatF <br />SNOP.K VTHORIZED BY THIS PERfd1T MUST BE STARTED WITHIN <br />1A0 DAYS OF DFTE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />