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Dale 12/9/83 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Lord Electric 2222 37th Street <br />Public Wmka Permit a �13 0 <br />Bldg Dept a 83/12798 <br />Public Works Fee S —�� Z 7 <br />TaW Fee <br />Lou APPr Fee Paid S n <br />Balance Due • w 7 <br />F <br />Everett 98201 259-2181 <br />Owner Mailing Address City Zip Phone <br />Garco Western P.O. Box 1521 Bellevue 98004 451-9048 <br />Applicant Mailing Address City Zip Phone <br />Construct Office Building <br />Describe Proposed Work <br />Prolect Address (if known) <br />615 80th Street S.W. <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 />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exfsting 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 shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specllicatiora <br />3. Cell Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1.800.124.5555. <br />4. Erosion control and right-of-way cleanup as directed by P/W Field Inspector. <br />S. Issuance of this permit does not constitute Public Works approval of <br />site/sloe stability. <br />Public Works notification/approval is required prior to beginning <br />installation of sewer and/or drain lines within the Hardeson frontage <br />slope. <br />App red for 59rCr Date <br />Arb72�_ <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPP,RTMEN (' <br />Ever tt, darWA Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />a <br />V/ <br />a <br />a <br />The undersigned owner/applicant herriby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, coats, <br />expenses, or causes of nction 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 Still to replace public property damaged thereby. <br />Signatur¢'ol Applicant Uate <br />WORK AUTHORIZED BY THIS ')ESMIT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUEL 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 />