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r <br /> 1 <br />� Date 9 z7 83 <br /> I PUCI¢Worxa Permil <br /> ApplicationFor B�ap.Deot.+ �3 I147O <br /> i PUBLIC WORKS PERMIT P�����WorWFee <br /> To�e�F�a s <br /> Less Aool Fee Paitl S <br />� Print or Type Only ee�e�«o�� S 1 <br />� � <br />� DON WliITE BOOKKEEPING 1624 Broadwav Everett 98201 259-9126 <br /> I <br /> Owner Mailing Address City Zip Phone <br /> JAY' S BUILDERS PO BOX 1051 Everett 98206 259-7070 <br />' Applicant Mailing Address City Zip Phone <br /> i <br /> ioescr�tearoaosedwork _ Add storeroom to back of xi� �ng huilrlin�* <br />; W <br />' ProjectAddress�itknown) 1fi2d Rrnadwa�+ . � <br /> Attach four(4)copies of ptans for proposed work• Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed sVuctures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. Ail calls for inspection shall be made 24 hrs. in advance- phone 253•88 i 5. � <br />� 2. All work shall be performed in accordance with this permit and current City of Everett Design and Conslruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �,, o ��� - O <br /> I � L � � 2 �� <br /> ��� �� � <br /> �� � � � <br />�� Q� o <br /> ' � <br /> - a �" �3 �' <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ' The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Cily ol Everett from any and all claim.^, for damages, costs. <br /> expenses, or causes of action that may arise because ol instailation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further ayrees to re�nove seme upon nolice Irom Ihe <br /> ApProved(or Construction Date Ciry and to replace public property damaged thereby. <br /> ,- FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> eve:ett PUBLIC WORKS DE-PARTMENT WOPK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> PROJECT OVER 90 DAYS DURFTION. <br /> C_ _ <br />� <br /> � � <br />