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«y�i[]-�i� <br />Ci7 [T1 � <br />� � x <br />C H <br />9 H !n <br />N � $ <br />� H <br />FG C] <br />H� <br />� H � <br />V1 H <br />H <br />z <br />Oyd <br />H�g <br />�V n <br />9H� <br />r z <br />F-i H <br />g�' <br />H <br />c�Cfn <br />��� <br />Z H [n <br />H O Cn <br />Daie_ 4/z9/93 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuoimVlww:Pcrmit. _ <br />eiao oec�. • 40410 _ <br />Pue�¢ wo�xs Fec S <br />Tolalice <br />L¢SSAp01 FeePei� S <br />aaia�cen�e 5 <br />William Snyder 2004 Lexington Ave Everett 98003 355-6194 <br />Owner Mailing Atltlress City Zip Phone <br />Owner <br />Applicant Mailing Address City Zip Phone <br />New �arage <br />Describe Proposed Work <br />Project Address (il known) <br />2004 Lexington Ave <br />Attach four 141 copies of plans for proposed werk - Draw to swle and note tne lollowing as appl;cahle: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on �he lot <br />• Exis�ing antl proposec utilities <br />• Centerline ol street <br />• Indic3te �Jorth <br />• Show any proposetl grading changes <br />• 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 pedormed in accordance with this permit and current Ci1y of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Jnderground Survice 48 hrs. hefore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />PUBLIC WORKS PERNIT <br />NOT REOUIqEO <br />8Y . <br />DATE � `� �%3 <br />AGKNOWLEDG[MENT Of CONDITIONS <br />W <br />� <br />� <br />The undersignetl owneqaPPlicant hereby agrees to hold and save harm� <br />--- less the Gly ol Everetl from any and all claims for damages, coste� <br />enpenses, cr causes of action Ihat may arise because of ins�allation <br />and maintenance ol Ihe improvement or oiher ri9hFof-way use here�o <br />applied for and �unher a9�ees to remove same upon notiCe �rom �he <br />r:pproved for Conslruction Date City and to replace public p�operty damaged ihereby. <br />FINAL INSPECTION Date <br />�ppmvetl as COnshucled Signa�ure ol Apphcanl Date <br />�� PUBLICWORKSOEPAR7MENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIIJ <br />/-��'� 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br />��� Everett, WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />\`'� Phone� 259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OP WORK ON THIS <br />� PROJECT OVER 90 DAYS DURATION. <br />