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�_ - <br />Date 9-z6-91 <br />Appllcation For <br />PUBILIC WORKS PERMIT <br />Print or Type Only <br />Vu�Lc Worb PermOp�1 _� <br />Biap peol � � 27 �YQ <br />Puolic Works Fee <br />Tatel Fee s <br />Laes Rppl. Fee PLE S <br />Balanco Due S <br />Jim Morgan 7423 Beverly Blvd Everett 98203 355-2436 <br />Owner Malling Address City Zip Phone <br />a,me� <br />Applicant Mailing Address City Zip Phone <br />Describe P�oposed Work <br />Pro�ect Address (if known) <br />7423 Beverly Blvd <br />Attach four (4) copies of plans lor proposed work - Oraw to scale and note the following as applicab�e: <br />• Proparty Llnes <br />• Outline and dimensions ol ell existing and <br />proposed structures on the lot <br />� Existing and praposod utililies <br />• Centerline of slreet <br />• Indicate North <br />• Show any proposed grading che�ges <br />• Show me�surements <br />PERMIT CONDITIONS <br />1. All cells lor Inapection shall be made 24 hrs. in edvance - phone 259•8810. <br />2. All work ahail be peAormed in eccordance with this permit and current City of Evurett Design and Construction <br />Stenderds and Specllications. <br />3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBtR 1-$00-424•5555. <br />f�� cvoz�-z��,,,� Na�`2e�-cu„ec(� � <br />/0-/-9/ <br />L o-a+�- �t.G�u �',�`u� �uc,� ,�c. �cuL'� a� -�x�;�,- <br />�� s��,� , �u� -��P ,aP� ,.,.1 %� ��.T.�� � � �� <br />,� �.�.�: <br />Approved tor Conslruction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />����PUBLIC WORKS DEPAFTMENT <br />3200 Cedar Street <br />Everet4 WA 98201 <br />Phone: 258•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the Cily of Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise becauso of instellation <br />and maintenance ol the improvemenl or other righFof-way use hereto <br />appliad lor and further agrees tu remove same upon notice irom the <br />Cily antl to �eplace public pronerty damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT IdUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. ThIIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />