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� N <br />b <br />C � <br />N <br />� n <br />M <br />H k <br />� M b <br />N M <br />� �3 � <br />o��j <br />N tnU R <br />G7 • <br />M¢ � <br />t^ y <br />N <br />N <br />C N <br />� ��.7 � <br />�3 O N <br />I �� <br />I -- <br />'�' � <br />Date lo-ln-`�1 <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />v�oi�c wor�s ve�mn . <br />ema oeo�.. 91/27954 <br />PueLCWorksFce 5 <br />Toiai Fee <br />Less Apo�. �ee PaiE $ <br />Baianco Due 5 <br />Lawrence NalUach 2132 Hi hland Ave Everett 9F;201. 252-7�150 <br />Owner Mailing Address Ci1y Zip Phone <br />Owner <br />Applicant Mailing Adtlress City Zip Phone <br />Describe Proposed Work Remodel. SFR• ll00 SI' <br />Prolect Address (if known) <br />Attach lour (4) copies o� P�ans lor proposed work • Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposetl grading changes <br />• Ezisting antl proposed utilities • Shuw measuremenis <br />PERMITCONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be pedormed in accordance with this permil and current City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />,; <br />/� ,�. . /, ,�, ., l� ;�'.'� / ,.:�<� . <br />� � l��L_�.{, Li <br />� �, <br />,; , <br />;1. . , <br />Approved lor Consiruclion Date <br />FINAL INSPECTION Date <br />ACP�oved as Consirucled <br />' PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259�6810 <br />LL <br />H <br />s <br />� <br />� <br />C <br />� <br />[ <br />HI <br />� <br />C <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/app�icant hereby agrees lo hold and sove harm <br />Iess the City ol Everett Irom any and all daims lor tlamages, costs <br />expenses, or causes ol aclion Ihal may arise hecause ol installatioi <br />and maintenance ol the improvement or other righ4of�way use heretc <br />applied tor and lurther agrees lo remove same upon nolice Irom Ih� <br />City and to �eplace public property damaged thereby. <br />Signalurc ol Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHI� <br />180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TC <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELIED BV THE GTY UPON ANY STOPPAGE OF WJRK ON THI; <br />PROJECT OVER 90 DNVS DURATION. <br />