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PUBLIC VvORKS PERMIT °•�°� �°"" ��24�9� — � <br /> � PUBLIC WORKS DEMRTMENT A,w�wo�s aerr�n• <br /> 3200 Ceder Stieat <br /> Everett,WA 98201 25a�eeio euudxq Permn• 56040 <br /> Tl'FE OR PRINT ONLY Publfc Works Fee S <br /> EDWIN PETERSEN 1524 GRAND AVE EVERETT 98201 258-2160 <br /> Owner Mailing Addieaa Cky Zip Phone <br /> i <br /> CONTACT: GFARGE BRUCE ti52-3281 <br /> Applkant MalBng.Midross CMy Zip Phone <br /> Describe Proposed Work REMODEL/ADDITION ■ ■ ■ <br /> W <br /> � <br /> � <br /> � <br /> PRWECT ADDRESS(f known) 1524 GRAND AVE � <br /> Attach four(4)coples of plens for�xoposed wak-Draw to scab and note the Iolbwing M epplkable: O <br /> 'Roperty Llnes �Outline and dimensbns ot ell existing arW proposed structures on the lot "Enisting and proposed utiXtlen <br /> �C8f11BfIIfIB C}SIfBBt �lndicate North 5h�w eny�xoposed g�adinp chanqes 'Show measurortbnts <br /> � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMfT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be pertomied in accordence with thfs pertnft and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Locatbn Underground Service 49 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5666. H <br /> 1�l a�- ��; � - t/� <br /> � O <br /> a <br /> 1�'f�G : � � ��I ba+�k-�t�r.,r v�l� � 5�d� �,r , <br /> �� i <br /> nc�wow�oae�Nr oF coriomor�s <br /> The und«aqned owneqappNeanl herebY a9reee to hold and seve hartnlee� <br /> the CHy W Everatl fmm any and ell cWms for danpges,coab,ezpunxs,a <br /> npp�oved r«corutruct�m oe�e oauses w a�ean mat may arix uecewe a rk uwnon arw mroc«w�o.a <br /> •the Improvement or other tipht-of-way u»heMu�pplf W/a rd Mlhx�paM <br /> to renave aartie upon rwtke fiom Me CMy and to nplate qippc pop�rty <br /> dameged thersby <br /> FINAL INSPECTION Date � � <br /> Appoved az Constructed �`� <br /> � Sign ure of Applicant �ats <br /> WORK AUTHORIZED BY THIS PERMR MUST BE STAFiTED WITFiIN 180 DAYS OF DATE PERMR IS ISSUF.O AND THEREAFfER IS TO BE DILHiENTLY PURSUED TO <br /> COMPLEf10N.THIS PERMIT MAY 8E CANCELLED BY THE CRV UPON ANY STOPPA(iE OF WORK ON THIS PRUIECT OVER 90 DI1Y3 DUMTION. <br />