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� -� <br /> �8t@ PuElle Work�Petmlt• <br /> Applicatlon For eior,.o•o�.• <br /> PUBLIC WORKS PERMIT �°°°W°^�F„ <br /> To�.�F.. s-- <br /> Uu�oCL FM P�IC s <br /> Print or Type Only �+�•��•o�. a <br /> Pplicatek No: B 41345 <br /> A Date• 0i/ <br /> Job A�ner.23161�pLUMBIA SEPA <br /> Owner � Tenant; HOLTHU3gp Phone <br /> Propoeed Uee: �Y�OND L . <br /> BEDROpy ADDrk' SINGLE FAt1IL� RESIDENCE <br /> ITION <br /> Applicant Phone <br /> OFFj�g gET <br /> Describe Proposed Work ApPR� FOR p—�J08 SET <br /> RMIT: DATE — <br /> ���—� BY <br /> � <br /> W <br /> Prolect Address(if known) � <br /> Attach four(4)copies of plans(or proposed work• Draw to scale and note the(ollowing as applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensfons of all exiating and • Indicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Exiating and propo8ed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CON DI`"IONS <br /> , 1.All calla for Inapqction shall be made 24 hrs.In advance•phone 259-8810. � <br /> 2.All work shall be peAormed In eccordance with thia permit end curtent City of Everett Desipn and Construdion <br /> Standarda end Speciticetions. <br /> 3.Cell Lacatlon Underyround Service 48 hrs before you tli4 TOLL FREE NUMBER 1•800�424-5555. � <br /> O <br /> PUBLIC WORKS PERMIT � <br /> NOT REOUIqED � <br /> BY B � O <br /> DATE .j � <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/applicent hereby agrees to hold and save harm- <br /> less the City of Everelt irom eny and all claims for demegea costs, <br /> expenses, or causes ol action that may arise hecause of Installetion <br /> and maintenance of ihe improvement or other right-ol•way use hereto <br /> applied lor and further agraes to remove same upon notice irom the <br /> Approved for Construction Date City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicent Date <br /> � PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStreat 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> Everett WA98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 pROJECT OVER 90 DAYS DURATION. , <br />