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� <br />8 15 90 �' <br />Date�— <br />��'l <br />�PU�LIC <br />Application For <br />WORKS PER11011T <br />�v-cD-zs-s <br />/ <br />�7�11 � <br />Pu�Lt Wo�b Permit + s� <br />eia9 oeo�. y 90�25406 <br />PWIic Wo�ks fee <br />TolalFee $ <br />LeSs Appl. Fee Pai� $ <br />� v� � g�i � � � t� �� I e�i��« o�� S 20 <br />Print or Type Onl� <br />N O O� O O � � ti�� <br />..-p� O hl M h�l � .-� U O <br />�.j W M M N M Cy <br />�O � � 481-3055 <br />R S Coleman 151� - 141st A� S� Snohomish 98290 <br />Owner � ������ �� 5p� � s�' City Zin Phone <br />� d���m � � tf5&S.�-�cs5 <br />o — <br />qpplicaid Mailinc� Address Ciry Zip Phone <br />Describe Proposed VJork <br />Project Address lif known) IAt 2. <br />:� <br />Short Plat 51-89 5 O-1 - M/� �� � so N ST <br />nnar,n tour 141 cooies ot plans lor proposed work - Draw lo scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed s�ruc�ures on ihe lot <br />� Exis�ing and proposed ulilities <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <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 peAormed in accordance with this permit and current City of Everett Design and Conatruction <br />Slandards and Specifiwtions. <br />3. C311 Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-42�1-55:i5. <br />� <br />O <br />'}��, �/Y�, ��cesi, g -u-90 <br />Approvedfor �ons ion Date <br />'�%� i��� <br />FPJAL NSPECTION Date <br />Ap?roved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />�� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259-8A'J <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant nereby agrees to hold and save harm- <br />less ihe Ciry of Everett from any and all claims lor damages, costs, <br />expenses, or causes of action thal may arise because of ins�allation <br />and mainlenance of the improvement or olher right-ot-way use hereto <br />applied for and luriher agrees to remove same upon notice irom the <br />City o replace public ro rry damaged thereby. <br />�--N�,.��� ���:�� <br />Signaiure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON AN'( STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />