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Date 'r� �_9'r <br />Application For <br />PUBLIC WORKS Pi PMIT <br />Print or Type Only <br />Mailing <br />ruM¢ Works Perm-/• � �{p — <br />eiAG Dept • �? ' �'" -- <br />Pudic Works Fes • <br />Total Fee <br />Less spot Fee Paid $ <br />asience Due S ` `)_y <br />01 <br />rJ AI-n '� City Zip Phone <br />Applicant Mailing Address <br />lLi ,a/ A=r/S!/NG 5, rQe //1 ro-1 _ <br />Describe Proposed Work t-E - T tit r.A"e"' am._ —�------- <br />IIvew <br />�. Lr <br />5 <br />Protect AI (if : nown) 'r / / 9 1i--9- 5 / r (G_ <br />Attach fovr (4) copies of plans for proposed work - Draw to scale and note the lollo e.g as line of applicable. <br />• Property Lines • Indicate North <br />treet <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures the lot • Show measurements <br />• Existing and proposedd utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in ,vancs - phone 259.881 5_ <br />2. AL 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 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />y 4A y f coo tE>r SioFct ,c L U.p F.v� y <br />S.f/igLL BE �'E�taCEO r' ANC- SAT,siocrinN <br />oer Tye Pv. � ie l rlo e rs ZvsvEc ro e <br />ylo <br />for <br />FINAL INSPECTION \ / <br />Approved as Constructed J �. <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone. 259.6815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />z <br />0 <br />0 <br />a <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 />anJ maintenance of the improvement or other right-of-way use hereto <br />apply d for and further agrees to remove same upon Police from the <br />City aid to replace public, property�amaged thereby <br />Signature of Applicant <br />WORK <br />AUTHORIZED <br />OFF DATE PERMIT ISEISSUED AND HEREA TER ISRMIT MUST BE STARTED H <br />IN <br />180DAYSTO <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 />