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H <br />9 k-3 CA <br />HxI�+ <br />'tlN� <br />VJ <br />NO H <br />OH <br />Nag <br />yrji� tinei <br />HH <br />g14 <br />f]CVHi <br />1-3 O (A <br />Date 7-23-91 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Work$ Permg a <br />Bldg. Dept a 91/27393 <br />Public Works Fee $ <br />Total Fee <br />Leas April Fee Paid S <br />Balance Due <br />Arvin Van Beek 1901 McDougall Everett 98201 252-3733 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Applicant <br />Address <br />Describe Proposed Work Carport/pole bldq 360 SF <br />Zip Phone <br />W <br />Project Address (if known) 1901 McDougall H <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following 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 />ICI • Existing and proposed utilities • Show measurements ca <br />' DO NOT WRITE BELOW THIS LINE O <br />PERMIT CONDITIONS <br />I"1 1. All calls for inspection shall be made 24 hrs. in advance -phone 259.8810. 7 <br />2. All work shall be performed in accordance with this permit and current City ,.f Everett Design and Construction <br />Standards and Specifications. <br />ICI 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. z <br />II O <br />1_1 <br />� /�u6� ���� /»�>� �r�` -•fig-„rr.�0 Cl) <br />"1 <br />' ACKNOWLEDGEMENT OF CONDITIONS <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <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 />