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� y � <br /> p� � . . {I <br /> k�� � r� <br /> Date 1�91 a�m�owo,k:ae,on. <br /> Application For ema�oaoi�•q�/ 81 8� <br /> ��� PUBLIC WORKS PERMIT °°°:o,aFa;F°° � — <br /> y x Lase Aoot Fee Pele $ <br /> �O� Balanto�ve $ <br /> G H o Print or Type Only <br /> ��g <br /> �� � <br /> � H Terra Firma Dev. 7211 Westminister Hwy Riclur,ond BC 278-5555 <br /> � H Owner Mailing Address City Zip Phone <br /> �y H <br /> O�H Luilder Millwnrk Stgpl,3i ��5�� N�124th St NirYlsld QA034 823-0696 <br /> n � Applicant Mailing Address City Zip Phone <br /> �0 y Describe Proposed Work _ mA„a�r _j,�,.�,,,_nt <br /> — . _ u <br /> W <br /> Prolect Address(if known) _ 1�'711 EvOTgTEeII Wdy – #C � <br /> Attach tour(4)copies ot planc for proposed work- Draw tp scale and note ihe following as apFlicaule: � ' <br /> • PropeAy Lines • Centerline ot slreet /� , <br /> • Outline and�fimensions of all ezisting and • Indicate North M� <br /> proposed structures on ihe lot • Show any proFosed grading changes <br /> • Existing and proposed utilities � Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O , <br /> PERMIT CONDITIONS <br /> 1� 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 1 2.All work shall be performed in accordance with this permit and current City of Everett Design and Const�uclion � � <br /> 1 ' Standards and Saecitications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> ' 1 <br /> �—� /�6� c���� /L�.�;�,�,�f�0 O <br /> 1 � �'G'. (f� I <br /> �' /Z-3 �9/ O <br /> � a � <br /> ►-� <br /> '�' ACKNOWLEDGEMENT OF CO�DITIONS <br /> 1 The und�rsigned owner/applicant hereby agrnes to hold and save harm- <br /> less the Ciry of Everett from any and all claims for damages, cost�. <br /> ' ezpenses, or causes oi action that may aise because ol installation � <br /> and maintenance ol the improvement or cther right-ohway use hereto <br /> applied for and lurther agrees to remove, same upon notice Irom the <br /> �J Approved for Consiruction Date City and to replace public property dama3eU Ihereby. � . <br /> FINAL INSPEC710N Date — I <br /> Approved as Constructed Signalure ol Applicant Date I <br /> PUBLIC WORKS DEPARTMENT WORh AUTHOflIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��� 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS 70 � <br /> �r Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> �� Phone:259-8810 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON TtiIS <br /> PROJECT OVEF 90 DAYS DURATION. J <br /> 1 <br /> i <br /> I <br /> I <br />