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t 9 — <br /> � �ate 8-23-91 � �O_ G 7_� Public WorNa Pmmlt• �/ ��� <br /> Application For <br /> oiee oao�.s 91/27590 <br /> PUBLIC WORKS PERMIT Pu�TollFeeFea S <br /> ��STIN6 II��7� �assAOP�FeaPeitlS_� <br /> 9S a.�a��oo�a s 2O° <br /> Print or Type Only <br /> OOZ - j?z `'�O -000-//-B3/ <br /> Dale A. Davis ZZ10 OakeG Ave Everett 98201 252-4304 <br /> Owner Mai{ing Atldress City Zip Phone <br /> Owner <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work SFR Addition <br /> W <br /> Project Address�il known) ZZ10 Oakes AVe � <br /> Attach lour(4)copies ot plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hre.in advance•phone 259•8810. � <br /> 2.All wo�k shell be pertormed in eccardance with this permit and cunent City of Everett Design and Construction <br /> Stenderds and Specilicetions. <br /> 3.Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> � C�� mA��-c�/�-fs�1 �2�no`z.�G .�-h� �CGtn.�v.,..0�Z�J_� O <br /> aLr�A: �ic R.a o�i�r�r.� 6(' �f,Y �u6�c u./ozl.:c� -G'�y�^" "" . <br /> ✓ <br /> J� �t�iu hJsca.f Lf¢ �G?[tCa' �ilOY�v L(i.c�� O� .uatuJa.�i ..�0 H <br /> �8.e o-�,S�,v�.� �y�r{e�� _�.e. ( �if�"'ox /5) � � <br /> /�"f �ne,.��(' �im.. � ,.C��c,�t�� Q,�-�a. .acaC�<,..t�Q�.� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett f:om any and all claims for damages, costs, <br /> ezpenses, or causes of action that may arise because ot installation <br /> ��� /,'� B_�d , p� and maintenance of the improvement or other righhot�way use he•eto <br /> 4a"F � applied tor and further a to remove same upon notice irom the <br /> Approved for onstr on Date City n lo place publ' pro erty damaged thereby. <br /> r <br /> � �-�Y-s'�- -�6 -g <br /> FINAL INSPEC O Date <br /> Approved as Constructed Signature o Applicant Date <br /> /A� PUBLIC WORKS DEP4RTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 �E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phane;259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVFR 90 DAYS DURATION. <br />