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, �iai9s S 352-94 pubbcWOrksParmll� � �I^ / <br /> Application For eida�oeo�..�644 <br /> ti <br /> PUBLIC WORKS P'�RMIT �,� PublicWorksFee <br /> G 1I a,�-_ To�a�Fae s <br /> .� pQST�N 1� Lessnpoi FeePe�d S <br /> Print or Type Only � � g g b � � !g g � g �'�'saw° s 2� <br /> � n vioci .;ro � � o a h :: m <br /> �;' N � w � `Qu' w i w .. .Rcar-, <br /> Madge ZwanR 101 7th St Davton OR� 9,"�14� 503-864-3011 0 � o b � <br /> Owner Mailing Address°o�.� �o CLLy z = z "- � �� � Phone <br /> � .r r< <� c..ivappp�y��, p� � wp � <br /> O pO.J0 ��J,[.�yJJ,('�jLsj :� i Z � O F 03 [A W <br /> � fFlA�919UJ 0�' J � J � p ¢ C� W : Z <br /> Contact: Jim Thomas Impression Desig� � a _ ti � yk � � � �� � _ <br /> Applicant Mailing Address City Zip Phonr. <br /> Describe Proposed Work NeW house <br /> W <br /> Proiect AdAress�if known) �� �� Eh�l�nd Au� _ � <br /> Attach lour(4) copies ol plans for proposed work• Draw to scale and note ihe tollowin�as applicable: � <br /> • Property Lines • Centerline af sireet � <br /> • OWline and dimensions of all existing and � Indicale Norih <br /> proposed structures on ihe lol • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance wilh this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> Gt, I� S�►I -r11rv �urb draY, �cr- skd -'$31�1 .�r G�r2ti+�S. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> — less ihe City ol Everett Irom any and all claims for damages, costs. <br /> `_ expenses, or causes ot action lhal may arise because of installation <br /> `•�--�� �a J and mainlenance of lhe improvement or other righl•ol•way use hrrelo <br /> �/ IieA for and funher agrees to remove same upon notice Irom the <br /> Appr ed lor CoD� ction Oate City and to replace public property damaped ihereby. <br /> C � <br /> ��-x�..d�---��-�- iU- �- 9�� �i�'//J �.f,Gl'� O/iL�''�,'�.`f �-6 �- J� <br /> FINAL INSPECTION Date /'�� <br /> Approved as Constructed Signcture ol Applicant Date <br /> � PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ,V�►'� 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � Everelt,WA 98201 BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS �URATION. <br />