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*/24/93 <br /> �8�@ Pu01ie Works Pormit• <br /> eieo oeot • 41�— <br /> Application For — <br /> PUBLIC WORKS PERMIT Pu0licWorkaFee <br /> Tot�l Fea s <br /> Len ApO�Fee P�iO S <br /> B�lance D�e S <br /> Print or Type Only <br /> I Kit Andreason 11111 lst Ave SE Everett 982�8 348-6227 <br /> Owner Maiting Address City Zip phone <br /> Applicent Mailing Address City Zip Phone <br /> Deacrihe Propased work PO�e Building <br /> W <br /> Prolect Address�il known) 11111 lst Ave SE � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the lollowing as app�icahle: � <br /> • Property Lines • Centerline ol street � <br /> • Outllna and dimensions of all existing and • Indicate NoAh <br /> proposed structures on the lot • Show eny proposed greding chenges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All cells far Inspedlon aheli he mede 24 hrs.in advance•phone 259�8810. � <br /> 2.All work nhell be peAormed+n accordance with this permit and cunent Ciry of Everetl Deslgn end Conslrudlon <br /> ' Standerda and Specitications. <br /> 3.Cell Location Underqround Service 48 hra before you dig.TOLL FREE NUMBER 7•800-424•5555. � <br /> O <br /> � <br /> PUBIIC WOqKS p � <br /> N T RE ERMIT O <br /> BY B OUIRED <br /> DATE .� 3"' A <br /> Ii <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unCersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Cily ot Everett Irom any and au ,,�c!�,a for damages, costs, <br /> ezpenses, or causes of action Ihat may arise because ol installation <br /> and maintenance ol the improvement or other iight-cf-way usr. hereto <br /> applied lor and further agrees to �emove same uprn notice irom the <br /> Approved tor Conslruction Date City and to replace public property damaged ihereF�. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dale <br /> � PUBLICWORKSDEPARTMENT WORK AUTHORIZED BV THIS FERMIT MU(iT BE STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> Evere�l,WA98201 BE DILIGENTLY PUFSUEO TO COMPLETION. THIS PERMIT MAY BE <br /> Phona:259�BB70 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />