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Date '/'x. 4 f <br />All hc:Uinn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Omer <br />Pu41K Perm <br />eI u <br />�EO Delit fDt 0 • l tiJ <br />NOW WD0.. Fee • _— <br />Total Fee <br />L... coot foe Pus • G �F GY' <br />eels... o.. • r. <br />C4Y Zi Phone <br />� Meiling Address <br />Appllcanl <br />¢,c(s <br />Describe proposed Work <br />% 0 — Y <br />Project Address (it known) <br />d work- Draw to scale and note the following as explicable. <br />Attach lour (4) Cowes of plans for propose <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall 6e made 24 ors. m advance • Phone 259.8815 <br />2. All work shall be performed in accordance with this permit and current City of Everelt Design and Construction <br />Standards and Specifications. <br />55. <br />3, Call Location Underground Service 4C hrs. before you dig. TOLL FREE NUMBER i •B00.424 3S <br />W <br />0-;'A <br />FINAL INSPtcrlury <br />Approved as Constructed <br />W <br />PUBLIC WORKS 0 <br />3200 Cedar Street <br />Everett. WA WORKS <br />Phone: 259.9915 <br />UJ <br />loom <br />0 <br />W <br />0 <br />sell <br />.AV <br />Q <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 afclaims 'or damae of nes, co t& <br />expenses. of causes of action that may arise <br />on <br />and maintenance of the improvement or othnr right•ol-wilt uF a hereto <br />applied �or and further agrees to remove same upon notice I cm the <br />City and to replace public property damaged thereby. <br />�%` ram' Date� <br />Signifilure of Appllcenl <br />IN <br />ISO DAY.S <br />TED <br />RTOF SS <br />DATE PERMIT E SUED AND THEREAFTER ISTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY RE <br />CANCELLED BY THE CITY <br />DURATION. <br />ANY <br />STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 <br />