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Date._ 1�0/`32 r.��,i��w��..>ve��„�i. <br /> ApplicaGon For eiov oau� • �559___ _ _ <br /> PUBLIC WORKS PERMIT P°°,oa�BOFBe s -- <br /> Less Nppl G¢E PaiO S <br /> Print or Type Onty aa�a��:�o�� S <br /> Ric:hard Brigman 6221 Bluff P1 Everett 98203 353-5&60 <br /> Owner Mading Atltlress City Zip Phone <br /> Owner <br /> Applicant Mailing Address Ci�y Zip Phone <br /> Describe Proposed Work �ditiOn t0 SFR <br /> W <br /> Prolect Address(if known) 6971 A1 nff nl _ � <br /> Attach Four(4)copies of plans for proposed work- Drew to scale antl note the following as applicable: � <br /> • Property lines • Centerline of street /w <br /> • Outline and dimensions of all existing and • Indicate North V, <br /> proposetl structures on the lot • Show any proposed g�ading changes <br /> • Existing and proposed utiiities • Show measurements � <br /> DO NOT WFITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> ?.All work shall be performed in accordance with this permit and current City of Everett Design and Const�uction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUNYBER 1•800-424-5555. � <br /> O <br /> � <br /> �b§��TWFf�OUIR�j31tl1P� � <br /> BY_ O <br /> DATE_1,/ s z a <br /> ACKNOWLEDGEMENT OF CGNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett iror*� .�ny and ali claims for dama9es, costs. <br /> expen5e5, or C3u5e5 of aCtio.^ �hat may arisB becausP of ins[alla'ion <br /> � and maintenance of the improvement or other right-ot-way use hereto <br /> applied tor and further agrees to remove same upon notice irom the <br /> Approved for Construction . Date Ciry and to repiace public property damayed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> � PUBLIC WORKS DEPARTMENT �NORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO I <br /> Everett,WA 98201 BE DIL16ENTLV PURSUED TO COMPLETION, THIS PERMIT MAV BE <br /> Phone�259-8810 CANCELLED BY THE "ATY UPON ANV STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 90 DAVS DURATION. <br /> � <br />