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C]' <br />ISM VIM' <br />Jz <br />5-20-91 <br />Data <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PubLc Wur Le Permd • <br />erdo Dept • 91/27030 <br />rubl.c Works Fee S <br />Total Fee <br />Less Appr Fee Pred S <br />Balance Due $ <br />James & Carolyn <br />Allendoer£er 5301 Ocean Ave. <br />Everett <br />98203 355-5570 <br />Owner <br />Mailing Address <br />City <br />Z_ip Phone <br />Solie Builders <br />7420 Juniper Dr. Everett <br />98203 <br />353-2331 <br />Applicant <br />Mailing Address <br />City <br />Zip Phone <br />Describe Proposed Work Addition & <br />Project Address fir known) <br />5301 Ocean <br />Attach fjur (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of 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 nroposed utilities • Show measurements <br />PERMIT CONDri IONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL HriCE NUMBER 1-800.424.5555. <br />Approved for Construction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />Ma- <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />z <br />0 <br />�A <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from 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 />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />:'t r <br />