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Date -_7 <br />�� Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />JC SeIIS 1`96 <br />Owner <br />Applicant Mailing Address <br />Describe Proposed Work <br />Project Address (it known) <br />Public Work& Permit e L05— <br />Bldg. Dept. e <br />Public Works Fee • <br />is al Fee ` <br />Lees IPPt Fee Ps-d • �a 0 <br />Balance Due tam <br />0 332 3 <br />gg2v% _9,5 9'7a70 <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 />• Existing and proposed utilities • Show measurements <br />rnone <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hre. 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 Specplcatlona <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />Us! <br />tttt� <br />N <br />0 <br />z <br />0 <br />0 <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 Jamages, costa <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 />oved for slructlon Date City and to repla a public property damaged thereby. �� <br />0� �113 QL -t71g3 <br />FINA IPISPECT N I Date <br />Approved as Constructed \_ SI ature of Applicant Date <br />everett PUBLIC WORKS DEPARTMEN W RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 18 TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 269.8815 PROJECT OVER 90 DAYS DURATION. <br />i <br />