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Apphc Tlion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />T <br />P ir)i i �D x7e t . <br />Owner Mailing Address City <br />Describe Proposed Work <br />ct.ei>i / <br />City <br />Public Worlu Permit • 17 / Z/ <br />d <br />Bldg Deer e % / 13 q3 <br />Pubbo Work, Fee <br />Total Fee <br />Lett APPr Fee Paid i <br />6clnnce Due i <br />i 1 — <br />— <br />W <br />Project Address (if known) /727— 70 po S. E <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />O Property Lines O Centerline of street <br />/A <br />O Outline and dimensions of all existing and • Indicate North <br />v♦ <br />proposed structures on the lot O Show any proposed grading changes <br />O Existing and proposed utilities O Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />0 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 his. In advance - phone 259.881 5 <br />all2. <br />All work shell be performed in accordance with this pernllt and current City of Everell Design and Construction <br />Standards and Specifications. <br />Cell Location Underground Service 49 his. before you dig TOLL FREE NUMBER 1.800.424.5555. <br />z <br />,3. <br />T• Tiir 'Al To Al?,4, /A6f' cSJ/ ,O:r! , <br />/� <br />,S �!aEu/9LK /S NE.✓ Gt vdeO�tEN � A�i9[iG.D.JT 7b <br />v <br />�EPl�4Gd �n/j/ Aging6f4 .•7�in/b c'at/Sn�vU70.c% <br />G. CJJE EX�S>r*/Cr [7,E�vEaJ'9f/. <br />�/� <br />,q,✓� G.PgDic cE a� �oT S.y9t c �E da✓E <br />o r <br />sp Ala, —To IMH9CT 44.7c, ✓i �/G L aTS kF/1ry <br />O� <br />,��,,�w90�,� e� � <br />a <br />Approved for Consb ctlon Date <br />a& - I (' <br />FINAL INSPECTION Date <br />Approved as Constructed <br />D <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 982018201 <br />Phone: 259-8815 <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 />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />