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Date <br />Applicetlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Plan Ch�ck No: B 43810 S8P7► <br />11pp1icat.Dat�: 03�16/96 <br />3ob 1lddrp�t 24 5 qIGHLi1ND 11VS <br />Owner Orn»rs PETTBRSSON DENNIS <br />T�nants <br />v� P[opo��d U��s SFR/O71R71GS <br />Pu01k Worlu P�rmil • <br />eiaa. o.o� • — <br />h01k Work� FN <br />Tol�l F�� _ <br />���� A00� F�� P�b S <br />I e.�.oc. ou. s <br />:ip P <br />D��c. of Work: <br />qpplicant D6l10 O!' EXT6 6AR)16E W/NBN 71TTACHBD G11It1►G8 :ip Phone <br />LOT CBAT /15-92 <br />OFFIC6 SST JOH SST <br />Deecribe Proposad Work _ <br />1�PPROVED FOR PBRMIT: D11TB_/_/_ BY <br />Proiect Address (if known) <br />Attach four (4) copies ol plans for proposed work • Draw to scale and note the tollow�ng as applicable: <br />• Property Linea • Centerline ol street <br />• Outline and dimenalons of all eztstinq and • Indicate North <br />proposed structures on the lot • Show any proposed greding chengee <br />• Eziatinp and proposed utilltiea • Show measu�ements <br />PERMIT CONDITIONS <br />1. All ulle for Inspectlon ehall be made 24 hrs. In advance - phone 259�8810. <br />2. All work nA�ll be peAormed In accordance with lhis permit end curront City of Everett Dealpn and Construction <br />Stendsrde �nd Speciflutlons. <br />3. Cell Loeation Underqround Service 48 hrs. before yau diq. TOLL FREE NUMBER 1•800•424-5555. <br />PUBLIC WORKS PERMIT <br />NO'f REOUIRED <br />BY <br />DATE ` �''� � <br />Approvetl for Construclion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby aprees to hold and save heim• <br />less the City ol Everett Irom eny end all claims for damages, costa <br />ezpenses, or causes ol action that may arise because ot instellation <br />and meintenance of the improvement or other righbof•way use hereto <br />applied lor and lurther agrees to remove 9eme upon notice irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PF.RMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO,IFCT OVER 90 DAYS DURATION. <br />