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� 3y <br />p <br />oar I <br />m pfISTING_z�<< <br />Woks Permit <br />Public W <br />Bldg Dept,s <br />Application For <br />._1z <br />m <br />PUBLIC <br />WORKS <br />PERMIT <br />Public TotalS <br />G <br />Less Appt Fee Paid S <br />O �j <br />/�nq <br />Balance Due $ 2 `� <br />Print Or Type Only <br />c " <br />002-302VO 83/ <br />ROf 1ti�NNR <br />'2�16 <br />3U%"`� s� � lG./ERC.YT ✓A <br />9&2Df •25ti-2t33 <br />Owner <br />Mailing Address ^ a Ar City <br />o m <br />Zip Phone <br />n <br />o <br />cfC+ls Av�'•./E".co� <br />9E?7z <br />fl�A(:fi St-fc[a1nIcE2 <br />t'�o2o <br />City <br />Zip Phone <br />Applicant <br />Mailing Address <br />/2.;nq. 5 1,•,'tocit <br />Describe Proposed Work <br />i y3/=/N6 5E c2 <br />1010!2c oc lsr"-S Fat ZSo' '/F� Stoic or- s,-,cccr. <br />Project Address (i. known) <br />5 903 l-N 2+ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />O Property Lines • Centerline of street <br />Outline , od dimensions of all existing and •Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • 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 performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />' e Rohe ",ocFe`4h -wirp-oriec Z)n 9/SAL <br />z <br />O <br />d <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further a gees to r ove same upon notice from the <br />A prov or Constr I ate City and to replac publ' propeif da aged thereby. <br />J <br />At <br />FINAL INSPECTION r D e ale <br />f AD and <br />Approved as Constructed <br />Signature o <br />WORF', AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />2200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8810 PROJECT OVER 90 DAYS DURATION. <br />