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Date 5-�o-9s =______= TO POSTIf�G_ fi-- �9-� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />& Pat Morton 3232 56th St SW Everett WA <br />Owner <br />rnawng <br />Mailing Address <br />Puobc works permit . �O � J U/ <br />Biag Deol + <br />lit Wo�ks Fee <br />Totel Fee $ <br />ILess ApPL F¢e Pditl S / <br />9aiance Due .S h� <br />002-3ySe3iz33/ -.• Bao <br />ooz-32Zya/�33/ -� S�?� <br />98203 wrk 258-6992 <br />Z�P Phnna <br />Describe Proposed Work SFR to office/apt 8ft1�XlI8�}gXX �- /!/ytiu Q�pLex nn <br />"- - - � -•- <br />Project Address (it known) <br />AttaCh four (4) copies ot plans for propo5ed work - Draw to SCale antl note the following as applicable: <br />• Property Lines <br />• Outline and di!nensions of all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />• Centerline of slreet <br />• Indicate North <br />• Show ar.y proposed grading changes <br />• Show measuremenis <br />Phone <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 pedormed in accordance with this permit and current City o( Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEq 1•$00-Q24-5555. <br />`f, S i`e wo�� fo Be �iarr� �e�' �oLa /� �/�Pr�de� on <br />,s ��/�3 6� fhe c�'tie�'e7i ,Uv6Lic l�o,eks ,j)e�o7`, <br />(�,Pf/ o �/a c%2o�) <br />•J %%� �C"v07�� 7�0� O�ouin S�Yiv7�S /i77�o <br />�-?"�L�+�1�70zY'3- J�/G�93 <br />Approved for Cons 'o Date <br />//-iP- 5's <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />�A�I� PUBLIC WORKS DEPARTMENT <br />3200 CedarStmet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />S�o��' Sew'P�-- <br />AChNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />V♦ <br />O <br />a <br />The undersignetl owner/applicar' hereby a9rees to hold and save harm� <br />less ihe City of Everett Irom a� and all claims for damages, costs, <br />eKpenses. or causes of action �I ft may arise because of installation <br />and maintenance of Ihe improven ent or o!her righbof-way use hereto <br />applietl lor and further agrees to remove same upon notice Irom ihe <br />City and to replace public property damaged Ihereby. <br />/ ' <br />�� �,� <br />%�,� �,�_ �-,� <br />Signature ol Applica t ' Date <br />WORK AUTHORIZED B1' THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TFIEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLEI ION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />