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� <br /> � <br /> l <br /> , ___ � <br /> � <br /> _�-z.�� <br /> Date 6�2B�90 � S Puouc worxs aermn+ ��32�O <br /> BIEg.Dept.r 90/24988 <br /> Application For <br /> PUBLIC WORKS PERMIT PuOTotalFeeFea $ <br /> Less Ap01.Fae Paid S , <br /> . Balance Due S ZD �' <br /> Print or Type Only I <br /> Rick Ditri 810 Washin ton Ave Mukilteo 98275 353-2490 <br /> Owner Mai4ing Address City Zip Phone � <br /> ocvner — <br /> : Applicant Mailing Address City Zip Phone <br /> � Describe Proposed Work .��s c�,G�],E-f3..�lj� RBSIC�P^�'� <br /> � W <br /> ; Project Address(if known) �'� F1oTida Dr. � <br /> ' Attach four(41 copies of plans for proF'osed work- Draw to scale and note the following as applicable: � <br /> � • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot � Show any proposed grading changes <br /> ' � Existing and proposed utilities • Show measurements � <br /> i DO NOT WRITE BELOW THIS LINE O <br /> '' PERMIT CONDITIONS <br /> 1.All calls for inspection shal�be made 24 hrs.in advance-phone 259-8810. � <br /> ' 2.All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br /> � Standards and Specifications. <br /> = 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �� <br /> � ACKNGWLEDGEMENT OF CONDITIONS '. <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less ihe Ciry ol Everett from any and ail claims for damages, costs. � <br /> ` expenses, or causes of action that may arise because of installation <br /> }.�_ � n ��7 C� ---7_1Z_v). anJ maintenance ot the improvement or other right-of•way use hereto <br /> �� O-x�x–`�� � a" applied tor and further agrees to remove same upon notice from the <br /> A roa tor Constr�ction /� Date ��ty and to replace blic property damaged thereby. . <br /> PP CCJC�i�I� -Y��� ��l/ � U �`( 9Q <br /> INAL INSPECTIO Date <br /> Approved as Constructed Signatu of p lican Date <br /> WOR AUTHO IZE Y THIS PERMIT MUST BE STARTED WITHIN � <br /> everett PUBLIC WORKS DEPARTMENT AYS OF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 pROJECT OVER 90 DAYS DURATION. <br /> i <br /> � <br /> I <br />