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T� <br /> �A� APPlication For ''4 � <br /> PUBLIC WORKS PERMIT oate 8/28/96 <br /> PUBLIC WORKS DEPARTM�T �jZ� <br /> 3200 Cedar Street a Public Works Permit# <br /> i �° PQSTING Everett.WAoap01 259-8� <br /> BuildingPertnitN 5�797 <br /> TYPEOR PRINTONLY� n apSTING NOV Q 5 a S g 8 � g g S� Oa <br /> 199J ,, vj N (� Pul�¢y�(orks Fee$ .�C._ <br /> ��� M � M M � M M� M�f <br /> LOUISE LIEN 2411 MAPLE EVERETT 98i�1 —6741 '� <br /> Jwner Mailing Address o.� Cit � �. i Phone <br /> � c�y� <br /> � GI 3� � � � � tT3 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work P�+CGMENT OF NEW MANUFACTURED HOME <br /> W <br /> F- <br /> '0p <br /> PROJECT ADDRESS(if known) 2411 MAPLE ST _/ <br /> Attach tour(4)copies of plans fo�proposed work-Draw to scale and note the tollowing if applicable: � <br /> •Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities O <br />� •Centerline of street •Intlicate North •Show any proposed grading changes •Show measurements <br /> p-- DO NOT WRITE BELOW THIS LINE � � <br /> PERMIT CONDITIONS: � <br /> 1.All calls fur 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 O <br /> Construction Standards and Specifications. <br />� 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> I?1 � �co�' �ro:.,�s �ai� 6u;l��;� �0 6� hza,Eed � <br />, o Si�/e-SaiuC/'. O <br />� J, ��!'iS7-iny Sio'�w4�i� OH /�et�J�G /1' /n �Uv ' � <br /> o� �'oi�o/„F�o n <br />, ahy d�,�a,E do„E 6y �h,-S w��,�,� s�4« �t r,:�<«��� <br />� �� �C Gcc:ne�"S �K�.'nGC . <br /> I <br /> � N � <br />� QG;�'10� //� /t�✓r <br /> i l�� ,'� 5� tipOk _ �'� w . �' „� ��bdl <br /> � <br /> /� ` G J � <br /> Se " `j o o/`r � - � lAN/" N /r <br /> 6 � � o� ��e � °� <br /> ,� � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harmless <br /> - � the Ciry of Everett from any and all claims tor damages,costs,expenses,or <br /> Appmv tor C ' tion a� causes of action ihat may arise because o(installation and maintenance of <br /> ihe improvement or other right-of-way use hereto applied for and further agrees <br /> to remove same upon notice from the City and to replace public property <br /> - f-�� damaged thereby. <br /> FINAL INSP n e <br /> ,arrA..r..r.,�.a ` , (�� �. <br /> 7 <br /> SI ature of Applica ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO 8E DILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPPGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATIGN. <br />