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Date—b/4SI <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO POSTING. <br />Mailing <br />Mailing Address uny <br />Antl¢Wass Permit. 9/ 1. <br />ry Dept Ica <br />Pnenc werb Fee 6 <br />Total Fee <br />loss eppl Fee Ps,d $ <br />t .:en.a a.. S 2C <br />U <br />) <br />Describe Proposed Work /�L✓ S 1 I r. i / " it P G e <br />Or <br />Protect Address lit known) 1NEA <br />Attach four 14) copies of plans for proposed work - Draw to scale 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 />• Existlrg if, I proposed utilities • Show measurements <br />rnone <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hisin advance - phone 259.8810 <br />l>♦ <br />2. All work shall be performed in accordance with this permit and current COY of Evorelt Design and Construction <br />07/1 Bi 91 9:07AM 000479 , <br />�'� 1 <br />Standards And Specifications. <br />3. Call Location Underground Seance 48 hrs before you dig TOLL FREE NUMBER 1.800.424.8555. <br />ELDG <br />vow <br />110DO27001 <br />S I <br />BLDG $477.50 <br />sew <br />FtBG S45.00 <br />MECH $60.00 <br />B SRCH $4.50 <br />� <br />DRVWY $20.00 <br />N00007249 <br />els,A,s <br />WATER $650.90 <br />Q� 1 <br />1100028290 <br />SEWER 11.79.Ni <br />SEWER $47t.00 <br />0 <br />SEWER $30.0Q0 <br />CHECY, :i1937.0,1 <br />APpr It off; )i�Ifuu/ction Date <br />'—FINAL INSPECf-10fi Date <br />Approved as Constructed <br />/ PUBLIC WORKS DEPARTMENT <br />Ma- <br />3200 Coder Street <br />Everell, WA 98201 <br />Phone. 259-010 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />WW <br />1� <br />rrrw <br />(n <br />03M <br />0 <br />z <br />O <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 arse because of inslagation <br />Intl mnmfanance of the improvement or other nghl-ofuse hereto <br />pplied for and further agrees to remove same upon notice from the <br />Ily and to rep-aco public property damaged thereby. <br />Synatwe 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 />