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Date�o f � � Pu41m Works Pormlt • <br />Applicalion For I em9. oen�. • 90/ 47 <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puolic wa�ks Fee S <br />Total Fee <br />Less Appl. Fee Peltl s <br />Balance Due J <br />Raymond Fletcher 221 4F F rr M ii w�, 353-5080 <br />Owner Mailing Address Ciry Zip Phone <br />O.mer <br />F,pplicent Mailing Address City Zip Phone <br />Describe Proposed Work Tenant ZmozovemPnt (axtor; nr) <br />Prolect Address (if known� <br />Attach four (4) copies of plans for proposed work • Draw to scale and note lhe lollowing as applicable: <br />• Property Lines • Cen�erline ol sVeel <br />• Outline and dimensions of all ezisti�g and • Indicate North <br />proposed structures on the lot • Show any proposed greding changes <br />• Existing and proposed utilities • SYow measurements <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Eve!ett 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 />' G�G ��%i"�/'-2 �_C/'ui��tG��li"i �yL`L2lC( <br />0 <br />Construction <br />FINAL INSPECTION <br />Approved as Cons�ructed <br />everett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98207 <br />Phone:259�8810 <br />Dale <br />Date <br />`-j�C : %L !�,cx`/ys-, <br />� =G—%O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersic�ned owner/applicant hereby agrecs to hold and save harm� <br />less Ihe Cily ol Everett Irom any and all claims for damages, rosts, <br />expenses. or causes ot action that may arise because ol installation <br />and mainlenance ot the improvement or uther right-ol-way use herelo <br />applied lor and further agrees to removc same upon notice Irom the <br />Cily and to replace public property damaged thereby. <br />Signature ol Applican� 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 B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PNOJECT OVER 90 DAYS DURATION. <br />