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Date� �� PuEl�c Wo�ka Pmmit fJ' —�7'�S3 <br /> Application For eiao.000• • _ / v <br /> �UBLIC WORKS PERMIT Publ¢WorFsiee --- <br /> TotBl Fee s <br /> , Lese Appl Fee Pp��O �� <br /> Print or Type Only Baiance0�e s 20— <br /> JFM Constivction 1231 South Director Street Seattle, WA 98108 7G3-0320 <br /> Ownei Mailing Address Ciry Zip Phone <br /> SdifIL <br /> Applicant IdaHing Address City Zip Phone <br /> Describe Proposed work ConstiVct Four Pler, <br /> ��9 �-�� .o W <br /> ProjeclAddress�ifknown) -�`-�'BroadwavAvenue. Er+erett. YtA � -o�. � <br /> Attacb lour(4)copies ol plans for proposed work-Oraw to scale and note the folWwio-3 as applicable: � <br /> • Property Lines • Cen�edinr ol street � <br /> • Outline and dime�sions of all existing and • Indicate I�orth <br /> pioposed strudures on the lol • Show an��pruposed grading changes <br /> � Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS L.IN�= O <br /> PERMIT CONDITIONS <br /> t. All calls lor inspection shall be made 24 hrs.in advance- phone 259•�881 5. � <br /> 2. All work shall be performed in accortlance with this permit and currenl Ciry ol Everett Design and Cons�ructien <br /> Standards and Specificalions. <br /> �. Call Location Underground Service 48 hrs �>elore you dig.TOL�FREFf NUM9ER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> .1CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> iess the City of Evere�t Irom any and all claims lor damages, costs, <br /> � expenses, or causes ot aclion thal may arise because of installaliun <br /> -�j('`.�-=_� _ �/�7 p� and mam!enance ol the improvement or other righbol-way use hereto <br /> ` � apG��'o 1or and luriher agrees to remove same upon notice Irom ihe <br /> Appioved lor ConEtructicn Uate Cdy and to reptace public property tlamaged thereby. <br /> 0.�-��%��� ' �l�y ��-r . ,�,an� C� iill �/�6 <br /> FINAL INSPECTION Date <br /> Approved as Construr.ied Sig ature oi Applicant � Date <br /> evere�t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS GF L'�ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED 8Y THE CITY UPON ANV'STOPPAGE OF WORK ON THIS <br /> PNOJECT OVER 90 DAYS DURATION. <br />