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TYPE OR PRINT ONLY <br />Jwner <br />� <br />Application Fw <br />PUBLIC WORKS PERMIT <br />Albert <br />PUBLIC WORKS DEPARTMENT :, <br />3200CedarSt2et ;,J <br />Everetl, WA 98201 259-8810 f <br />�� <br />TO POSTING �EB o s 2002 <br />� <br />�� <br />'i..i � <br />]7 BerkshireiDr "�Ev 98203 425•-3 <br />�ate �'ZZ'9g / <br />Public Works PertnR k 7 8�'Z Z 4 <br />Building Permit A 59576 <br />a�m�� we� F� a <br />>o 00 <br />193 <br />Phone <br />Owner " <br />Applicant MailingAddress '� �' �� Ciry Zip Phone � <br />Describe Proposed Work <br />PROJECTADDRESS (if known) <br />r <br />540R Fairview Ave <br />Attach four (4) copies of pians for proposed work - Draw to scale and note the toilowing if aaplicable: <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Exisling and proposed utilities <br />'Centerline of street 'Indicate North 5how any proposed grading changes 'Stiow measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-4245555. <br />� �eP c��i s��r`� c��.Qh � aLL -f:nes <br />S, Zrsf4,LC .srle sec,✓c� �e� c��y s�n hda r d� <br />�O/ (OZ, ���� 6/Z <br />�. �ilp vjc% 4nf/ �r'x t�'�G Co�'>1`�o a 4l a�ir[ ef�Co� <br />�� �Lic �USL,•G cvor,fs ?ht�¢c�or. <br />c s cnon ���� <br />/ i <br />��%'—� � 2 L <br />'f-- <br />Approved as Constructed <br />W <br />� <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDI110NS <br />The undersigned owner/appliwnt hereby agrees to hold and save hartnless <br />the Ciry of Everett from any and all claims fo� damages, costs, expenses, or <br />causes of action that may arise because oi installation and mafntenance ot <br />tFre improvement or other rigM•of-way use hereto applled for and 1urtl�er egrees <br />to remove same upon notice trom the City and to replace public property <br />damaged thereby. <br />X � ���� <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY WRSUED TO <br />COMPLE710N. iHIS PERMIT MAY BE CANCELLE� BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS W RATION. <br />