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8-26-91 �J <br />oB1B JO POSTING zks- DY�•P•m"� <br />4�"�yrL I awa .Pt. 91/2759 <br />Application For a <br />PUBLIC WORKS Pf%RMIT �,iA1 wKwPh.Flo - <br />Fe. <br />p 1...A LF.. P... <br />� <br />O it rg i.nw 1 <br />Print or Type Only a ow . z <br />O OMOJ <br />J <br />N D)iN co 03 <br />� MMM � N S Nn] 7 <br />MM <br />OJ <br />2820 86th St BE Y•Everett 9�08 ram" <br />Gary Harstad 337-4654 <br />_ <br />Owner Mailing Address $ _ �.i Phone <br />Oather <br />Applicant Melling Address City Zip Phone <br />_ <br />Proposed Work new SPRwaaaaaaaw <br />Describe <br />pyC <br />W <br />_ <br />(if known) 5330 <br />Project ,ddreSS <br />Attach four (4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br />• Property Linea • Centerline of street <br />• Outline and dimensions of all existing and • Indica a North <br />/w <br />v+ <br />proposed structures on the lot • Show... proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS <br />1. All calls for Inspection shell be made 24 him in advance - phone 25"810. <br />I <br />2. All work Shell be performed In accordance with this permit and current City of Everett Design and Construction <br />Standards and Spedflcatlona <br />S Call Location Underground Service 48 him before you dig. TOLL FREE NUMBER 1-SW-424.5555. <br />z <br />lot <br />Fla <br />W9/ <br />a. <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEIMRTMENT <br />3200 Coder Street <br />Everett. WA 98201 <br />Phone.. 259-8910 <br />r/0- <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm <br />lees 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-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and t9oreplace public ropedy damaged thereby. <br />93rr�/ <br />Signature pf pp icant Date <br />WORK AU HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />