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Dater�s <br />Applicetlon For <br />PUBLIC WORKS PERMIT <br />Prf�t or Type Only <br />Owner <br />J 6 D <br />1429 <br />nuw aea <br />Deacribe Proposed Work SinRle FBmily ReeidenCe <br />Pro�ect Addrees (il known) <br />Everett <br />PuElic WorM� Parm11 • �� �3� <br />eiep oa,a • d' / �'/GO <br />PuEllc WorFs Fae <br />�o1si Fes � <br />le�� Appl Fee P�iE �i <br />Ba�ence0ue i!'� 2n�Lr�% <br />7f�al �7 <br />98201 252-1166 <br />Z�P f�hone <br />96201 252-1166 <br />Z�� PhOne <br />Attach lour (4) copies o� plena lor proposetl work • Drew to ecale and notw Iha lollowing ae appliceble� <br />• ProFerty Lines • Centerline ol street <br />� Outline and dimenslone ol all axiating and � Indicate Norlh <br />prop09Bd st�uc�urea on �he lo� • Show any propo&ed greding chenges <br />• Exieting end proposed utllllles • Show meesuremenls <br />PERMIT CONDITIONS <br />1. All calle lor Inapecllon shall be mede 24 hrs. in advana• - phone 259-8815. <br />2. All work shell be perlo�med In acco�dance wilh Ihis peimit entl current City of Everelt Design end Construction <br />Standarda end Spacificatlons. <br />3. Call Locatlon Undergiound Service 48 hrs, betore you dig. TOLL FREE NUMBER 1•800-4245555. <br />npprmen ror coneVUeTiOn DBte <br />fY�fvv,-e.� � I Zco%dS� <br />FINAL INSPEC N Oate <br />Appioved ae Conatructad <br />everelt PUBLIC WORKS DEPARiMENT <br />� 3200 Cetler Sireat <br />Everett, WA 98201 <br />Phone: 259-8815 <br />AGKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned owner/npplicant hereby egrees to hold and seve harm- <br />less the City ol Everett from pny and all clalms lor damages, cost& <br />expenses, o� ceuses ol action Ihat may arise beceuae ol inatellation <br />end maintenance o� the improvement or other righl-ol�way use hereto <br />applied lor end luriher aB�ees lo remove reme upon notice Irom the <br />Cily and to �eplace pu6lic p�operty demaged ihereby. <br />� / c, ' <br />� � , ,, :. c. - i �,. � �' f�. � : /� s <br />Signalwe ol ilpplicant � —p ��g <br />WORK AU7HORIZED BY THIS PERMIi MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />