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Date-4647 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner Malting Address City <br />Public woke P01.0 0 87-70 <br />Bldg Door • ,]G% / 7 •9 6- <br />Public Works Fee <br />Torol Fee <br />Leto seer Foe Pa,d i <br />Eaton@ Due <br />Applicantt Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if knownl <br />.Cor *5` <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: ' <br />• Property Lines • Centerline of street <br />• Uutline 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 />02 <br />PERMIT CONDITIONS <br />I. All calls for inspection shall be made 24 hra In advance • phone 259.8815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />S1A06A- 'c.CS CZIVa Gu/TE/L q eF .✓Ec✓ It aCt/DAM9r�o <br />LJN1 414 "9GE To 7.✓E.n Lrw.9C4 FJE REPLACED ar 7,,e- <br />S Lo7 /S To BE G.e.oaFo So ,9s n,./or, Ta <br />THE Ao.%..✓.+,uG- COTS 4.J/7/1 P!,,A*1 97A4 RvlwcW <br />`p ifoof - 7,,P X0 BE TiE.o /n/7Z7 DQAiN,!6-x5_ <br />STf/STEM, <br />'.'� vd67ze� lAdti ,t7�Ili.�'E7v <br />v <br />Appruved forConstruction f I Date <br />Arran u 11( �'61 <br />FINAL. INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />Ever tt, WA Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />ff <br />U) <br />M <br />0 <br />z <br />0 <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 />end maintenance of the Improvement or other right-of-way use hereto <br />applied (or and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />ISIS pnelure 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 />