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Date gY�X� 3/30/92 Tn POSTING ��_, Z?-9'1 <br />Application For <br />PUBLIC WORKS PERMiT <br />Print or Type Only <br />� <br />PuOLc Works Permit � �/ Y � <br />em9 oeoi � <br />Pu�lic Works Fee <br />Toini Fee S <br />Less Ap01. Fee PaiU S <br />Baiance Duc <br />S -'' � G �'�� <br />Robert Brokaw; PO Box 25:4 . Eberett 98206 742-1717 <br />Owner Mailing Atldress � � . Cily � ; '� � : 2ip Phone <br />Applicant <br />Mailing <br />Describe Proposed WorkNeW �—unit mulit—famil <br />Project Address (if known) <br />CiIY Zip <br />Altach four (4) copies of plans lor propOsed work • Draw to scale and note the followinq as aoulicaMe� <br />• Property LineS <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show mezsuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 his. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with ihis oermit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-800•424•5555. <br />�' l l_� <br />/, C Fi� L< oz .�� �C � �[n✓ �O.lu.,. <br />�..i,f Cc;)�a� :Y C2�Jf19rt.���i� <br />Q,af C L�-('ii��CL ��i.<(�(e c����:7_/�-= iCD.�i. <br />�� <br />LLl // h<"f'. <br />Approved for Con Iructiqn(/� � Date <br />/j �— <br />✓C/ �G- �— � � � — /' �' � � l`� <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 />S /' ' l'`' <br />/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unde�siqned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everetl from any and all claims for damages, costs, <br />expenses, or causes ol action �hat may arise because of inslalla�ion <br />and maintenance ot the improvement or other right-ol�way use herefo <br />�pplied lor and further ac�rees to remove same upon notice M1om the <br />Ci1y and to replace public property damaged Ihereby. <br />Signature ol 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 DILIGENT�Y PURSUED TO CJMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />