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i ( <br /> Date� jp POSTING � PueecWo�xaaerm�t� ? 27" <br /> Blag DaO��+�68b 2 <br /> qpplication For <br /> PUBLIC WORKS PERMIT Pu���cWorksFea <br /> Total Fee S <br /> Less ApO��Fee Pa�a S �C �� <br /> Batance0ue S <br /> Print or Type Only OOZ- 377yn/�93/ <br /> Bill Bourland 8818 3rd Ave SE Everett WA 98208 353-8522 <br /> � Owner Mai{ing Address � City . 2ip Phone <br /> Owner <br /> - Applicant Mailing Address City Lp Phone <br /> Describe Proposed Work new consttuction 4—plex <br /> W <br /> Prolect Address�if knownl 8822 3rd Aye SE � <br /> Altach four(4)copies of plans lor proposed work-Draw to scale antl note the lollowing as applicable: � • <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions oi all existing and • Indicate No�th <br /> proposed structures on Ihe lot • Show any proposed gratling changes <br /> • Existing and proposed utilities • Show measuremen�s M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work ahall be pertormed in accordance with ihis permit and current City ot Everett Design and Construction <br /> Stanoards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> ,/ � / O <br /> 7 .-� �' Lv��- .X lu' C��,,; `2�iz R(rrn,z. <<f'f'i1�Z�<.✓� c�L g/.;1i�' <br /> I// Y�i: TCcN.G��/ Ie'�Cili[ c�[�..: C�e�'4/��i,v�.:� CO�J�f4.l�iCf <br /> ✓ O � <br /> S, /��_� c r��� sfr�c7` ll��;,� � � �ll f.�,� s . � <br /> G, r�.�r�'L� .���� ..Sc�<.��z �-ti ���r j ,f-��-���1<,��C�, G�n/, �2 �� �c�s� � <br /> /O�y �.c.i4�/�!� �. <br /> l <br /> ACKNOWLEDGEMEM�OF CONDITIONS <br /> 1 <br /> The undersigned owner/apP�icaM hereUy agrees to hold and save harm- <br /> less the Clty ol Everett irom any and all claims br damages, costs, <br /> expenses, or causes of action ihat may arise because ol installation <br /> l� /� � '7 and maintenance ol �he improvement or other right-of�way use hereto <br /> "7C'z�-"'�— '7 // Z ypplied for and luriher agrees to remove same upon notice Irom ihe <br /> nnn�o� r Construction a« City and to rep;ace public property damaged thereby. — <br /> ������ `� = l�� �r--C.-.�'�, �18�� z- <br /> FINAL INSPECTION Date Date <br /> Approved as Gonsiructed � SignaWre o A p cant <br /> WORK AUTHORIZED BY THIS PEflM1T MUST BE STARTED WITHIN <br /> �A�I�� PUBLICWORKSDEPARTMENT 180 DAl'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200Cedar£ireet BE DILIGENTLI' PURSUED TO COMPLETION. THIS PEFAIIT MAV BE <br /> � Everetl,WA98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 OF.YS DURATION. <br />