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i <br /> � APPI��catian For i;;_ <br /> PUBLIC WORKS PERMIT ��te IZ—zz-9s <br /> ,-. <br /> PUBLIC WORKS DEPARTId�NT puhlic Works Permit q ���__ <br /> 3200 Cedar SUeet � <br /> Everetl,WA 98201 � 259�0 50385 <br /> ('� q /+ •'�� Building Permit tl <br /> � �{t1�1 I��U � c� o c r_�. n g o c v i <br /> TYPE OR PRINT ONLY� � o r�� o vr ri gublic�qr�s�kee$ � <br /> � c� ,o ,u w ai u� N m •u <br /> W w� w w M .r. r.� �o <br /> Lyle Blank PO Box 2266 Everett �20�' 355-4735 � � �+ a <br /> Owner Mailing Address o.� o Ciry � -- � Z > Phone <br /> a n � �ry = x �3' $ wo .F`ic ii <br /> �y O L fi� V U �; O V— 0 3 (�l W <br /> O J J U� 4_ [� cT. p W 1 <br /> wner r` scma. ru�, ox =sx cninc <br /> Applicant Mailing Address '" City Zip Phone <br /> Describe Proposed Work new house <br /> � <br /> � <br /> � <br /> PROJECTADDRESS(if known) 7121 Jefferson St Lot 1 SP IC1202-29-95 � <br /> Atlach four(4)apies o(plans for pmposed work-Draw to scale and note the followirg if applicable: � <br /> •Property Lines •Outline and dimensions of all existing and pmposed structures on ihe bt •Existing and proposed utilities O <br /> •Cemerline of street •Indicate Norih •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. o <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � � �//��i- /�/��� The undersigned ownedapplicant hereby agrees to I�old antl save harmless <br /> ��� vf��n C� the Ciry of Everett from any and all claims for damages,costs,expenses,ar <br /> � r'"��' —�� causes of action that may arise because of installation and maintenance of <br /> AppmvedforConstruction Date theim entor therrighbof-wayuseheretoappliedforundluriheragrees <br /> g / to r ove a u n notice from Ihe City and to replace public property <br /> Ci� `�� ( U mage t reb <br /> FINAL INSPECTI ate � / ��� <br /> Approved as Cer.�tmded <br /> ure of Appli ant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED N'ITHIN 160 DAYS AT P RMIT IS ISSUED AND THEflEAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS FERA1IT MAY BE CANCEL�ED BY THE CIN UPON ANY STOPP OF WORK ON THIS PROJECT OVEH 90 DAYS DURATION. <br />