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Date -a -1 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City Zip <br />Public work, Pei I a 9�" 6 O <br />aide Dept a <br />Public Work, Fee <br />Tolat Fee S — <br />Lan Abel Fee Paid _ <br />Bale", Due $ 20 i <br />Phone <br />Describe Proposed WaltKyjl) L>r—lp— — <br />Project Address If known) <br />Lorr**f- <br />tom' <br />Attach four (4) copies of plane for proposed work • Draw to state and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. In advance - phone 259.8815. <br />2. All %work shell be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. -Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />�1�. .S/.LI�Lel.9GiC' #- Cutest <br />Any v977,f*s ro <br />dy T.YE Ha�c.cv,.�v: <br />Til6/x-7 -0yALL <br />B6 <br />[tvf�.¢oC•E.�. <br />'0PE.0['9c'rw <br />.5 TiE ,Pori-= Tds0 irJro Paac.c Dei9 ✓yc� <br />A// / 6 ,4-0.1 4b ON GOT TO 466 /OZMI C So f9S A1497 70 <br />r <br />.74i Tif6 SVA>,eoyiao✓&i L noT.r e✓.ro/ 101101/✓!a�P&A,101 . <br />UJ <br />z <br />0 <br />1M <br />U) <br />O <br />a <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 />^� ,•, <br />//� <br />expenses, causes of action Ihel may arise because of eta <br />and maintenance of the Improvement or other right-of-way use hereto <br />- <br />applied for and further agrees to remove same upon notice from the <br />Approved for COMM it <br />Date <br />City and to replace public property damaged thereby. <br />/CD <br />FINAL INSPECTION <br />Date <br />Approved as Constructed <br />o of Applicant r IDate <br />Signature of <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLIC WORKS DEPARTMENT <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8815 <br />PROJECT OVER 90 DAYS DURATION. <br />