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Date 1 ail 1 /.!93 �� 53 <br /> r, Public Permit# <br /> oa Bldg.Dept.# <br /> AOplication For 1) <br /> PUBLIC WORKS PERMit* <br /> Public Works Fee <br /> Total Fee $ <br /> 8 Less Appl.Fee Paid $ I. *y--�'' <br /> 8 Balance Due <br /> $ !/{/ <br /> Print or Type Only a. <br /> , ; , <br /> . 1-Y243J 7 <br /> ALBERT C HEIDE GOO, Colby Ave, #3 alivakett Wash. 98201 2511423#j <br /> Owner Mailing Address 0 an Zip Phone <br /> ggsame as above .1 <br /> Applicant "-Mailing Address City Zip Phone <br /> Describe Proposed Work See on agj acent blue 'print. <br /> W <br /> Project Address(if known) r. <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: m <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and �''° • Indicate North (II/II) <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 ' O <br /> 1, <br /> 1.All calls for inspection shall be made 24 hrs.in advance phone 259 8800. <br /> 2.All work shall be performed in accordance with this pernTit and current City;tof Everett Design and Construction <br /> Standards and Specifications. '� <br /> 3.Call Location Underground Service 48 hrs.before you dig.'TOLL FREE,,NUMBER 1-800-424-5555. z <br /> r <br /> CO <br /> -e-,,' ,12/.7r-vv.-eci 12 l'7,1 C IA-1-..e,1 /o72e/.75 <br /> 1 a' 0. <br /> - <br /> — ACKNOWLEDGEMENT OF 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 causes of action that may arise because of installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> App for Con uc / to appligd for"'and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> //AA / <br /> FINAL INSPECTION Date C 14�_ lv`� r1'ity <br /> Approved as.Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION'THIS PERMIT MAY BE <br /> a Everett,WA 98201 <br /> Phone:259 8810 CANCELLED BY THE CITY UPON ANY STOPPAGE'OF WORK.ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />