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��� <br />A�x <br />�Hx� <br />yZH <br />FC C] <br />oH� <br />"{IH� <br />pJ H <br />��p <br />HC <br />��g <br />(�] Y (7 <br />t"y� <br />HH <br />gy <br />Ot7N <br />G � <br />HO(�i� <br />Dat� �_�"�—Q2 <br />�iw <br />Application For <br />F�UBLIC WORKS PERMIT <br />Print or Type Only <br />PuoLt Wo�xi vmmil . <br />eiaoo�ai.• Q7/'�565� <br />Gu0!¢ Works Fee 5 <br />Tolal Fnq <br />�eis AppL Fee Pa�O 5 <br />C+aivnce Oue 5 <br />JAMES RUBIO 1809 AICDOUGAI.1. EVF.RETT 98201 339-2690 <br />Owner htading Address �i�Y Z'p '''°^e <br />EVERETT BUILDERS 5606 EVERGREEN WAY EVERETT 98203 353-7161 DON PIANN <br />nr.nlicant M1lailing Atldress City Zip Phone <br />Describe Proposetl work FOUNDATION UNDF.R EXISTING HOUSE <br />Pwiect Address (il known) <br />Atlach tOW (4) Cop�es O� plans for pro0o5Btl work • DraW t0 SCale antl note lhe follOwiry a5 appli[able: <br />• Property Lines <br />Y Ou�line antl mmensrons of all existing antl <br />proposed structures on the lot <br />• Existing and p�oposed utilities <br />• Centeriine ol street <br />• Intlmate North <br />• Show any proposetl gratlmg changes <br />• Show measurements <br />PERMITCONDITIONS <br />1. All calls for inspection shell be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be peAormed in accordance with this permit and current Cily ol Everett Design antl Conslruction <br />Standards and Specifications. ' <br />3. Call Localion Underground Service 48 hrs. 6elore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�� �l� Ul ['l?J --� �,C.' Ln�^—� �L�� ��..C'_� <br />lor Construction <br />Date <br />=1NAL INSPECTION Date <br />4pproved as Constructed <br />PUBLIC WORKS DEPAFTMENT <br />3200 Cetlar Streel <br />Evere�t. WA 98201 <br />Phone: 259�88t0 <br />�� <br />% % 13 ' Q � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />i� <br />O <br />�, w�I <br />I•, <br />LJ <br />ihe undersigned owner/apPlicant herehy agrees to hold and save harm- , <br />less Ihe City of Everett Imm any and all daims �or damages, costs. , <br />�expenses, or causes of action that may arise because ol inslallation � <br />antl maintenance of the improvement or olher right�ol�way use herelo � <br />applied lor and lurther ag�ees to �emove same upon nolice Irom the <br />City and to replace public property damaged Ihereby. � <br />Signature ol Applicant Date � <br />WORK AUTHOFi1ZED BY THIS PEaM1T MUST BE STARTED WITHIN . <br />700 DAYS OF DATE PERMIT �� �SSUE� AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO C�iMPLETION. THIS PEHMIT MAY BE j <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br />PROJECT OVER 90 DAVS DURATION. <br />