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i i? ��, 9- <br /> Applicaiion For <br /> � PUBLIC WORKS PERMIT °a'°-- �9—� <br /> PUBUC WORKa DEPARTMENT Publir'Noiks Pertnit If � <br /> 3200 Cedar Slreet <br /> Everett,WA 90201 259-8810 � Building Pertnit k 51555— <br /> 1 � � <br /> TO POSTING � —�" publicNarksFee$�C,F�� --- <br /> NPE OR PRINT ONLY <br /> LYLE E BLAt;K PO DO): 2266 EVERETT 98203 355-4725 <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City ZIP Pnone <br /> NEW HOUSE - BASIC�' ����96 1�ODFM OOORN59 KK'k:K <br /> Describe Proposed Work ���'3`— W <br /> -- — N00051834 ■ <br /> Fl Fr r <br /> q00051555 � <br /> n n pt£G s63�-45 � <br /> PROJECT ADDRESS(if known) �_ ` U p��T f I]� ��O?3��y0'r 2 t6efl0'r r1.t3i] M <br /> SRCfIRG f4.50 Yr1 <br /> Atlach four(4)copies of plans for proposed work-Drew to scale and note the following it applicable: � f s,�.� O <br /> •Property Lines •Outline and dimensions of all existing and proposed slructures on ihe bt 'Ezislin�and pr�,t i�1�Ues <br /> O Y <br /> •Cenlerline of street •Indicate North •Show any proposed grading changes •Show measurements �� S70 � ^ <br /> ♦ <br /> DO NOT WRITE BELOW THIS LINE � � k048.60 � <br /> PERMIT CONQITIONS: CHECf� <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2. All work shall be performed in accordance witii this permit and current City of Everett Design and <br /> �onstruction Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE t1UMBER t-800-424-5555• H <br /> `�, As �e,-�.�bl,c vYo�Kf ���iv✓Cd �lcy d�fcd 5�6�9� � <br /> 5. In �l�c �.bse.��e o{a� -F;rz dc�ar-��e,z-F d/'/��ved -n��h a,��^d - O <br /> �tie tiou.re en •f-h;r /ut �usf ��s�rl � reslde�f'al �'� �. <br /> 5���� Klcr Sysfen�. <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> /� The undersigned owner/appiicant hereby agrees to hold and save harmless <br /> I��1i /� ���n n � 2 C the City of Everett from any and all claims for damages,costs,expenses,or <br /> c�� �•-� � causes of action that may arise because of installation and maintenance of <br /> A�edbrConstrython Dare theimprovemenlorotherright-of-wayuseheretoappliedforandluAheragrees <br /> �,% �_ to remov same upon notice irom the Cily and to replace public property <br /> ��_- �'� 7- >L dam he ��� <br /> �� l <br /> FINAL INSPECTIO Dale <br /> Approved as Construded � <br /> i me of App cant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DAT RMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSl1ED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPP E OF WORK ON THIS PROJECT OVEP 90 DAYS DURA?ION. <br />