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� <br />� <br />App�iwli�n Fur <br />PUBLIC WORKS PERMIT <br />. I11,1 O 3 2007 PUBLI3 00 Cedar StreR; MENT <br />V UI� <br />Everett. WA 98201 259-8810 <br />- i' � ������1, ,,� 5 - (�-o� <br />TYPE OR PRINT ONLY <br />Jeremy rtoore 5808 <br />Owner <br />Owner <br />Applicant <br />Describe Proposed Work <br />Mailing Address <br />Mailing Address <br />new duplex <br />PROJECT ADDRESS (if known) <br />12-3-9E <br />D.te-------- ----- <br />Public Werks Permit k __J .q1�L-- <br />/ <br />Building Permit k _. _�.QO�__— <br />Public Works Fee 5 �� � — <br />BB <br />Y1 Everett 98203 425-347-8915 <br />City Zip <br />Attach four (4) copies ol plans for proposed work - Draw to scale and note Ihe following il applicable: <br />•Property Lines 'Outline and dimensions ot all ezisting and proposed structures on the lot •Existing and pmposed utilities <br />•Centedine ot street •Indicate North •Show any pwposed grnding changes •Show measurements <br />LINE <br />PERMIT CONDITIONS: <br />1. AII calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed 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 />7 �X�GG C�, 5c1a .� o->- Cr1�'l 6�sv+-- �/s� <br />�j � o�ch r� �'7`/ U <br />G�1s-CG�C C�7�sT�ho��.hU�+5�7�Z _ <br />c�r�c���-.� � <br /><c�vn.c�f� � a�rc�, .f�..c�i•v ,7� S:ce�itec.:.�� <br />/��c d�.�:��.�y oz�" .� s-8�c� <br />�'���, � .�l.�.°..�� c� s������� c�� <br />� ,�L .� ,�.L� ������'.z�/.�. {',-�-,d�--,� .s.�� <br />!Jl' CLd�,cCd-Gci� SD' A�c��+' CCt.>.� �j/Jli� /1/t.!'Ju-^'���QGt.M.�. <br />0 <br />6 <br />lc• <br />T <br />8. <br />� <br />O <br />ACKNOWLEDGEMFNT OF CONDITIONS <br />The undersigned owner/appfcant hereby agrees to hold and save harmless <br />Ihe City of Everett irom any and all claims tor damages, cosis, expenses, or <br />causes of action that may anse because of installation and maintenance of <br />lhe improvement or other right-of-way use herero applied for and further agrees <br />W remove same upon notice trom the City and to replace publir, pmperty <br />damaged thereby. <br />�i-�-f-� a 7 - (5' GF'� <br />Si Wre of Ap i nt Date <br />AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAVS OF OATE: PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />_ETION. THI� PERMIT M4Y BE CANCELLED BY THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />