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�� <br />1YPE OR PRINT ONLY <br />qpplicatlon For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stree.t <br />Everett. WA 98201 259-8810 <br />Joe Pentz 4816 S 3rd Ave <br />Mailing <br />Describe Proposed Work install <br />R/R tiec <br />PROJECT ADDRESS (if known) <br />area aleng S 3rd Ave <br />/.A1(. c 'lrrl Ave <br />/ <br />Date 2-15-96 <br />Public Works Pertnit a�(�'� � r�� - <br />/ <br />Building Permit q <br />Puolic Works Fee 5 -0- <br />5 <br />ZiP Phone <br />Z�P Phone <br />cu� out lawn 6 install <br />Aflach four (a) copies ol plans for proposed work - Draw to scale and nete ihe following it applicable: <br />•Property Lines •Outline and dimensions ol all ezisting and proposed stnidures on the lot •[aisling and pmposed utilities <br />•Centedine of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls tor inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />���a��� <br />n� Q 5 1996 <br />M,,,. <br />... ............. <br />CITY OF EVEREI'1 <br />puildinr� Dlvis�on <br />� <br />O <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplir.aN hereby agrees to hold and save harmless <br />the City ot Everett from any and all claims tor damages, cosis, ezpenses, or <br />causes ot action that may arise because o( installation and maintenance ol <br />ihe improvement or other right-ot-way use hereto applied br and further agrees <br />to remove same upon nolice hom ihe Ci1y and to replace public propeAy <br />��I�_- Y damaged thereby. <br />D �.� 9 <br />FINAL INSPECTION - / <br />Approved as Consimcted �, Q? � � <br />licant Date <br />S na e of App' <br />COMPLETION. TH SDP RMIT MAY BE CANCELLED 8Y THE CITYIUPON �hNY SOTOPPAGE O WORK ON THIS PROJEC O CER 90 DOAYSEDURIAT ONLY PURSU[D TO <br />