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-1 <br /> �a�e P�011c Work�Perml�• <br /> Appllcation For eiao.o•o��• <br /> PUBLIC WORKS PERMIT °°°'kW°�.F� <br /> 7mN Fa� � <br /> Last�DD�F��P�1a S <br /> eH.nc.oa. S <br /> Print or Type Only <br /> APPlicatck NO° B 41345 <br /> Job Addree' ���19/93 SEPA <br /> Owner � Pro T�ent;ZHOLTHgENB�yMOND Phone <br /> DeecP�ofdWo=k; SINGLE FAyILY RESIDENCE <br /> BEDROpy ADDITION <br /> Applicant Phone <br /> OFF2Cg gET <br /> Describe Proposed Work RPPR� FOR p-JOB SET <br /> RHIT; DATE - <br /> ����� BY <br /> Project Addresa(if known) � <br /> � <br /> Attach faur(4)coD�es ot plens for proposed work• Draw to scale and note the(ollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> � • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> � Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells tor Inapectlon shall be made 24 hrs.in edvence•phone 259�8810. � <br /> 2.All work ahell be peAormed in accordanca with this permit and current City of Everett Design and Conalrudion <br /> Standarda and Specificetlona <br /> 3 Cell Location Underpround Service 48 hrs.betore you dl4 TOLL FREE NUMBER 1•800�4245555. � <br /> O <br /> PUBLIC WORKS PERMIj' � <br /> NOT qE0U1RE0 � <br /> BY B � O <br /> DATE ..3 � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned awner/epplicant hereby agrees lo hold and save harm- <br /> less the City of Everett from any and all cleims tor damagea costa <br /> ezpenses, or causes of ection that may arise beca�:se of Installation <br /> end maintenence of the improvement or olher riglil•ot•way use hereto <br /> applied lor and further agrees lo remove same upon notice from the <br /> Approved tor Construction Date ���y and to replace public property demeged ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Construcled Signature ot Applicent <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��r� PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS .TO <br /> 3200CedarStreet gE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON AN'f STOPPAGE OF WORK ON THIS <br /> Phane:259�8810 PROJECT OVER 90 DAYS DURATION. , <br />