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,ace � - - -- -... .. - <br /> Bbp.Oem.• <br /> �j� Application For <br /> PUBLIC WORKS PERMIT `°°'�w°"„°° <br /> iatm Fee 5 <br /> Lna�col fee�a�C 5 <br /> 9aunee Du� 5 �r C�'��"CG. <br /> rint or Type Only <br /> MRS. h1ARY H.4RTMt1N 2721 Wetmore Everett , l4A 93201 258-�411 <br /> Owner Mailing Atldress City Zip P�one <br /> NEWLAND CONSTRUCTIOid CO. . INC. P.O. Box 958 Everett l4A 98206 259-9191 <br /> ppplicant Mailing Address City Zip Phone <br /> efcriheProposeOWork Place 8 ' X 18 ' jobshack in alley adjacent to building <br /> during remodel of existing office building. _ <br /> � <br /> �ectAddresslifknow�) 2939 Colby � <br /> ttaeh four(4)copies of plans lor proposed work- Draw to scale and note the tollowing as applicahle: � <br /> � Property Llnes • Centeriina of street � <br /> • Outline and dimensions of a�l ezisting ano • Indicate North <br /> proposed structures on the lot � • Show any proposetl g�ading changes <br /> • Existing antl proposed utllities • Show measurements � <br /> DO NOT WRITC- BELOYJ THIS LIVE <br /> PERMIT CONDITIONS � <br /> 1. All cal�s for insoectio�shall be made 24 hrs in advance• phone 259•881 5. � <br /> 2. All work shalt be pertormed in acccrdance with this permit and current City of Everetl Design and Con ruction g � � 'I <br /> Standards and Specilications ���Z�� ' <br /> 3. Cafl Location Underground Service 48 hra before you dig.TOLL FREE NUMBER 1-800•424•555 � <br /> G��G//ap� �C�PJV���.d% �� rs � <br /> A� <br /> r _ �S S//�"d'`���/�f—T�/f���� <br /> � L ��vK£ �. Lr � �i �r '� / �"" <br /> �N �Qati � !�/,P� V� <br /> AN � �.�c � P..� �o-� � � <br /> O.� � <br /> //-Z•• P8 <br /> ACKNOWLEDGEMENT OF CON�ITIONS <br /> The untlersigned owner/applicant hereby agrees to hold and save harm• <br /> — less the Ciry ot Everett Irom any and all claims lor damagea coste, <br /> expenses, or causes of action that may arise 6ecause of Installation <br /> and maintenanee of the improvement or other �ght•of•way use hereto <br /> aoplied lor anC lurther agrees to remove same upon notice fram the <br /> roved lor onstruction �, Date City and to re c p blic property damageC thereby. <br /> -� - ,�1�, ,�'��• X � /� -,z� -.�� <br /> AL INSPECTION Date pate <br /> roved as Constructetl 5" �C� �'Y Signamre of Appiicant <br /> WOPK AUTHOPIZED BY ?HIS PE�tMIT MUST BE STAFTED W�THIN <br /> everett PUBLIC WORKS DEPAFTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFT£R IS TC <br /> � 3200 Ceaar Street BE OILIGcVTLY PURSUED TO COMPLET70N. THIS PERMiT MAY 2E <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STGPPAGc OF WORK ON TNIS <br /> Phone: 259•8815 ocn!r'�^'�'? 9q OAYS OI:P�TION. <br /> � -�->� <br />