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Date 4-2911 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />%02 jd .1�e545W 4S*%94771 <br />Public Works Permit # <br />Bldg. Dept. # <br />Public Works Fee <br />Total Fee $ <br />Less Appl. Fee Paid $ <br />Balance Due $ 2 <br />P r7 /9 <br />owner MaMng Address City Zip Phone <br />27-1 <br />� <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work 'Ilk iN 0_x-c(Ak Fz�YR i•! N t y,0ACt, ( r 0-4,0— <br />/ 1A l3 l$C r �Cig Q <br />i <br />Project Address (if known) �+^" o-1- W &rVekc� 04 9��K <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 />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All 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 />p I,c t2�2 C i <br />Approved for Con tructio <br />Date <br />P <br />FINAL INSPECTION <br />Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />04/29/91 2:15PM 000A#6718 <br />/ <br />ZVEI ID* <br />DPT.20 $20.00 <br />CHECK $1210.00 <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 damages, costs, <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 />City and to replace public property damaged thereby. <br />`r71 <br />Signature of Appfdant 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 />