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Date 12/17/91 �'�3�2���- <br />Application For <br />PUBLIC WORKS PERMIT <br />Tn nncTi►�r _ 1z_ '_ �= <br />Print or Type Only <br />�I] <br />/ <br />Pu�lic Workf Permn • �� /��� <br />aiaaoeo�.• '�SORG <br />vumlc wodf Foa s <br />To1el Foe <br />Leas Rppl. Fne P�i� s <br />BOIOIICBDUO S �^ <br />2 47–/117 "...." . _. <br />Mai�ing Address City Zip � -, Phone <br />Owner �. - � - _ <br />� <br />Malling Address Cily Zip ��• ,� Phooe <br />Applicant . - <br />New 1418sf rambler <br />Describe Proposed Work <br />Prolect Address (if known) Sr ` "' � " ' ' ' � —� <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the Ioliowing a' appleit abie. <br />• Property Lines <br />• Outlina and dimnnsions of all existing and <br />proposed structures on the lol <br />• Exfsting and proposed utilities <br />�':�7:,1f:"! <br />_., � <br />. ..._ � . _ -.., <br />• Cenlerline o s re <br />• Indicate North <br />• Show any Proposed gradi�g changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for InsPection shell be made 24 hrs. in advance - phone 259-6810. <br />2. All work shell be peAormed in accordance with this permit and current City ol Everett Design and Construction <br />Stendards and Specilicetions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800�4245555. <br />�, Cv,�.tP�� �v��►� rts�r'�2-�.h�s o� s►�e�r�. P\aE.. <br />(-��y_--_ '`-�-- ��`• �� K�9" � z' ZO' `3� <br />Approved fo truction q Date <br />� ��6�� <br />FINAL INSPECTION�'�� ate <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everetl WA 98201 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City of Everetl trom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because of installation <br />ancl maintenance of the improvement or other right•cf�v+ay use hereto <br />applied for and furt er agrees to remove same upon notice trom the <br />C� d to repla e tic property damaged thereby. <br />Signature of Applicant � Date <br />WORK AUTHORI2ED 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 />