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41277 Application For <br /> UBLIC WORKS PERMIT Date 2-14-96 <br /> PUBLIC WORKS DEPARTMENT Public Works Permit# —`6/077 <br /> 3200 Cedar Street <br /> Everett,WA 98201 259-8810 %J �j op Building Permit# 50884 <br /> TYPE OR PRINT ONLY +V 6`� J ff <br /> �� �. Public Works Fee$ �,�/������"/ B 50 <br /> Henrickson Hugh PO Box 5641 Everett WA 98206 658-8917 <br /> Owner Mailing Address City Zip Phone <br /> Owner <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work new pole building 03/0 /96 541F,1 000A#46_7_ lire <br /> f W <br /> O05088-`_-.=.'LJ $469 a 0 <br /> SRCH%.G $4.50 <br /> 4fn096077 r/ <br /> r._v v= <br /> PROJECT ADDRESS (if known) 5931 -tipe- 1.-A wor retA, DRI Wv 1?,Ord <br /> -GRAM $64.J0 <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: L4`V $558.50 <br /> 'Property Lines 'Outline and dimensions of all existing and proposed structures on the lot 'Existing and proposed utilities O <br /> 'Centerline of street 'Indicate North '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. <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> 0 <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br /> 4 • fib° 4-' S-keys 6G4 oti t -lit , Cin <br /> in sine mac 401 1 yelYVG-fra r%nce 0 <br /> 6, Eire,s;oi c 7 t f s 'tea' 141-e <br /> o lif"Z"‘‘J'Y' 449recle <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> / the City of Everett from any and all claims for damages,costs,expenses,or <br /> Approved for onstruction Date causes of action that may arise because of installation and maintenance of <br /> the improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> ..7.1eL <br /> AK <br /> Signature of plicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />