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� <br /> Date 11 25 87 87_ �� <br /> PubIK WONu Pe�m�!a <br /> ADP��cation For e�.nec�., <br /> PUBLIC WORKS PERMIT ���KK'ork�FM <br /> talal Fee s <br /> 1P65 Rppl FrC�T�d $� <br /> Print or Type Only e�.,.,-�c,,,. s 20� <br /> Barl Person 7721 wrr n n 258-347 <br /> Owncr Mailin Atltlre55 '�, t 9820� <br /> 9 Ciry LP Phone <br /> Cobra Construction Co , P,O. Box 1299 , Everett 98206 258-3667 <br /> Applicant Mailing Address CIty Zip Phone <br /> DescribeProposedWork The west section of the a�artment on 7of_12 44at Sr +� <br /> is settlinR. We are ¢oine to dig a test ho7e rt, 77 y rn �t r r e <br /> condition of aub rade. <br /> ��� _ W <br /> Proiect Address�if known) � <br /> Atlach four(4) copies ol plans for proposed work• Draw to scale antl note Ihe lollc.ving as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and dimension5 01 ali ezisting and • Indicate North <br /> proposed structures on Ihe lot • Show any proposed gradmg chan�es <br /> • Existing and proposed ufilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed in acwrdance with this permit and current Ciry of Everell Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /��,e A���y�a S,e�;c� O <br /> � <br /> � <br /> � <br /> . ; .: a <br /> ACKNOWLEDGEMENT QF CONDI110N5 <br /> The undersigned owner/applican:hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, cosis. <br /> � ezpenses, or causes of action ihat may arise because of insfallation <br /> ���j_ �� and maintenance ol ihe improvement or olher right-of�way us2 he.eto <br /> aoplied lor and further a rees to remove same u on notice trom the <br /> Apprcved lor Constr ction � / Date City an/d to�replace publio property/damaged Iherehy. <br /> _�� Date � V7��1�7L1t �Q�:4�f.J l� /2 � <br /> /� " . v� �' <br /> FINAI INSPECTION <br /> Approved as Constructed Signature ol A plican� Dale <br /> everctt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 1N0 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERIdiT MA1' BE <br /> Phone: 259�8875 CANCELLED BY THE CITV UPON AIJY STOPP�GE OF WOqK ON Tlil,^i <br /> PROJECT OVEq?0 DAYS DURATION. <br />