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l <br /> pate z�8/84 <br /> Pu01iCWork�P���1z sy � <br /> Application For eioo�oea.• <br /> PUBLIC WORKS PERMIT P�blicWorksFee <br /> 1 . . , Total Fee $ � •d �' <br /> Lec�AO��Fae PaiC S <br /> Print or Type Only e.�, ce Due s �" � c'e <br /> ; 6�ry� <br /> Snohomish County Teachers Credit Union 1718 Broadway Everett 98201 259-2138 <br /> Owner Maiting Address City Zip Fhone� <br /> Newland Construction Co. inc. P.O. Box 958 Everett 98206 � 259-9191 <br /> Applicant Mailing Address City Zip Phone <br /> Addition to existing building <br /> Describe Proposed Work <br /> Project Address(il known) 7 � � Tti�'� w a� � <br /> Attach four(4)copies ol plans lor proposed work• Draw to scale and not Ihe following as applicable: � <br /> • Property lines • Centerline of street � <br /> � Outline and dimensions of ali exieting and • Indicate North <br /> proposed slructures 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 O <br /> 1. All calis for inspection shall be made 24 hrs. in advance• phone 259•861 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construciion <br /> Standards and Specifications. <br /> 3. Call Location Underground Service4B hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> Y Oj/G�/ /i/GCC.S�T JC /ii//"�" ''-�J / C^ O <br /> �J:-..- � <br /> C�/T�' cS�T/9/i�/°.�1' //Y/�'��'fi9r✓z'c� Gv/Ti5/ <br /> a�Ji��� SSS //rI�'�E�'y�77r=-✓T ��f�irK� � <br /> /yl��'r �n� �s-��,�r��l.�`t-o �/f�i.���� �9.,.�o O <br /> �� �� ,�,�,��� �,��;� o,�,�� a <br /> T� ���'�y_ <br /> � cv/ti �� �f`�'��� �y.��� <br /> S F�j �� ��.Cd �S�. ACKNOWLEDGEMENT OF CONDITIONS <br /> O/l� /�7�� �n� The undersigned owner/applicant hereby agroes to hold and save harm- <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> _�� expenses, or causes of action that may arise because of installation <br /> � �c� and maintenance of the improvement or other right-ohway use hereto <br /> �' � �� applied for and further agrees to remove same upon notice irom the <br /> Appr � d for Cons ction Date <br /> City and to replace public property dam�ged Ihereby. <br /> _---�__�1�-�- �-� �--�r � _. <br /> FINAL INSPECTION Date ��c£r=—.—��i` ��u�w.oa�.�� Z-/o-vq <br /> Approved as Constructed Signature ot Applicant Dale <br /> evzrett PUBLIC WORKS DEPARTMENT N10RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 100 DAYS OF DATE PERfd1T IS ISSUED AND THEREAFTER IS TO <br /> Evere�t,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phon=: 259-8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />