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SEAT Ta rigAcr6 rR%6 /Z -' S -57 <br />Date % 7O B 9 Public Wo*a Permit • — V / _�• / <br />Application For Bldg. Deal. a <br />PUBLIC WORKS PERMITPublic Woos Fen — <br />Total Fnc $ — <br />Less APPL Pee Paid S <br />Print or Type Only Ba''al ce Due <br />FS)LL �i�ILc�1 Hr�Y[ <br />Owner Mailing Address City Zip Phone <br />F1"LS--1 Fo, 13gc 100 Pm�rr `I62-06� <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work Lc,]'-3 u�-r L- I4 e LPT ,���•S Pi��ii IJ (a <br />Lli KL!S rin I e-ALz5! <br />UJ <br />Project Address (if known) <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 />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS BDDOS031J <br />O <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 5. DPT.20 <br />2. All work shall be performed in accordance with this permit and current City of Everett DgsigV_Vd Cop*lfyctlon <br />Standards and Specifications. yl C <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.8V`424.555."�` <br />JJJ YS,,,hht 1r4J. J:.I <br />S'TrE Lvare< To �a Covfrnvrr � /�Ee �i�i?O!/dF0 *gji0 b1877. 0 <br />t/S i3714.20 <br />O <br />�� fj�o�EiC9 e/T is t'EQc e� Ta Ds�aicorE S r Gc/i�E <br />SFC%Io�TJ p/' �p.W. FcT% %/hF Sio.�c'rl.9ciC <br />Ta, A��GiCP.rJr /S •1'.E'QCJ/"P6,O Tp �2ov/t7E •A f�E.tFoc'/nA.VCE O <br />G'v.Pe9.vr� FiZ �,��� Fa, SiGKcuPcc I�.LS:'Fcc/riat� <br />Lc /9;17 0L <br />NPPfOved for 1:0n�� �Qate� <br />FINAL INSPECTION to <br />Approved as Constructed <br />everrtt PUBLIC WORKS DEPARTMENT <br />EverCedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />ACKNOWLEDGEMENT CIF 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 uauses of action that mat, arise because of installation <br />and maintenance of the improvement of other right-of-way use hereto <br />applied lot and fur}her agreCs to remote same upon notice from the <br />Srafdre of Appli " path <br />WORK AUTHORIZ D Iv IU ST BE iARTEU WITHIN <br />180 DAYS OF DATE ERMIT I SSUED AND THEREAFTER IS TO <br />BE DILIGENI-LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY SIOP13AGE CF WORK ON THIS <br />PROJECT OVER ^0 DAYS DURATION. <br />