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� APvlicatian For <br /> PUBLIC WORKS PERMIT oa�a— s-�-9� <br /> PUBLIC WORKS DEPARTMENT Public Works Permit q <br /> 3200 Cedar Street <br /> Everet�,WA 98201 259-8810 Building Permit a 55028 <br /> TYPC•OR PRINT ONLY Public Works Fee$_. <br /> David Van Deren 2405 Baker Ave Everett 98201 <br /> Owner Mailing Address City Zip Phone - <br /> D Peterson Const David Peteraon 259-7250 <br /> Applicant Malling Atldress City Zip Phone <br /> Describe Proposed Work 88TH8e _ ■ , ■ <br /> W <br /> _ � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) 2405 Baker Ave � <br /> Attach lour(4)eoples of plans for proposed work-Draw to scale and note the following If applicable: <br /> •Property Llnoa �Outline and dimensions ol all existing and proposed structuies on the Int •Ezistinq and proposed ulilitles O <br /> ` 'CeMedine of street •Indlcate�,��h •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: 2 <br /> 1.All calls for Inspectior. shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Constructlon Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �Ib �V�IiG YYcN�CS 'N� m�'G ��. � <br /> �' a <br /> � <br /> � ��r��,c � s I�x.�� a�r +� <br /> �x�S�� yY,�e se�..�e✓– V rrdc S . S . � <br /> wt,¢��' (�QG • o �r r�c lo cc�+e�� o�+s�d�e <br /> �+ �n'�-�- �{ 5�,,-�.�. <br /> ACKNOWLEDGEMFNT OF CJMDITIONS <br /> The undersigned owner/applicant he�eby agrees:o hold and sava ha�mless <br /> ihe City ol Eve�ott Irom any and all claims lor damages,costs,exponses,or <br /> Approved for Consiruction Date causes of action that may adse becausa ol Installalion and maintenance of <br /> the improvement or oth�:r right-ol-way use hereto applled for and lurther agrees <br /> to remove same upon notica Irom Ihe City and to replace public pmperty <br /> damaged ihe�ehy. <br /> FINAL INSPECTION Data �—�/�` �/1 <br /> Approved as Constructad x a�—�� `/ � <br /> Slfl atu,of Appllcanl / E 6/���L� Date <br /> WORK A�THORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DiLIGENTLY PURSUED TO <br /> COMPLEfION.THIS PEqM1T MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVEP 90 CAYS DURATIUtI. <br />