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� <br />� <br />Date eii5i4� � <br />i�] <br />PU�LIC <br />b <br />Print or Type Onl� <br />M <br />R C Coleman o <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (il known) <br />Application For <br />WORKS PERMIT <br />tnOO V�10 d O m0 �t <br />,N-ia�.�i r�.i � M�i�� <br />� N N � � N M N <br />.et M <br />) - 141st �e � Snohomish <br />� � � ml�d ��a �ii � � �5 <br />Mailinq Address <br />�%�-Z� -S <br />Publ¢ Wods Permlt a �' •—' <br />BIdB� Dept e �,.� <br />Publlc Works Feo <br />Total Foe g <br />Less Fppl. Fee PaiC $ <br />oaiunce Due S � <br />481-3055 <br />Zip Phone <br />Zip Phone <br />Lot 4- SP 51-69 519 MA�isOtJ ST <br />Attach four (4) copies ot plans for proposed work - Draw :o scale and nole the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed s:ructures on the lot <br />• Ezisting and proposed u�ilities <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />w Show measurements <br />P[RMIT 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 with this permit and current City ol Everetl Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you di9. TOLL FREE NUMBER 1•800•424-5555. <br />Qa,.-�1L JYl `'L_s-e-. 8?�-9O <br />Approvei for Constru^ . , Date <br />�i/ � � �� � <br />FINALIN E 10 Dute <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />�none:259�8610 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />/ <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />le.ss ihe City of Everett from any and all claims for damages, costs, <br />expenses, or causes ot action that may arise hecause of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />appli�d for and furiher agrees to remove same upon notice from the <br />ity�nd to replace pub � roperty damaged thereby. <br />/ �7�1.�--�_ 7 ' <br />Signature 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 />CFNCELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVFR 90 DAYS DURATION. <br />