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I.3 ca <br />ty 1 <br />tt4 O <br />htl H� <br />Hy <br />pzO <br />O H C <br />�08 <br />y�Y n <br />t'IH� <br />Hy <br />gC4 <br />1~ <br />rA <br />O to <br />Date _1 /24/91 <br />M <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />ild <br />Public Works Permit e <br />Bid, D.11. a 91/26325 <br />Public Works Fee <br />role l Fee S <br />Less aePL Fee Paid S <br />eslance Due S <br />_ Clyde Barcelou 2315 Hoyt Everett 98201 259-6925 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed WorkBa�r��iL'—ds1100aoe t0 1st floor & add 2nd floor addition <br />W <br />Project Address (if known) 1821-bcdou9al <br />Attach four t4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />Illlllltt� <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />/A <br />v+ <br />1_I <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />�A <br />DO NOT WRITE BELOW THIS LINE <br />WO <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance - phone 259.8810. <br />Construction <br />1 ' <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />f 1 <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424-5555. <br />z <br />��f <br />�U fj far/ Gr�o ✓'y 7�Cir�w7r /U� lee/J <br />O <br />a, <br />_ <br />0� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DERARTMEN- <br />3200 Street <br />Everett, WA 98201 <br />Phone: 259-6810 <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 />expense3, 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 />L 1 <br />