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Daley _ ° r <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />R. A. Sperline Inc <br />Same <br />Describe Proposed Work <br />23006 107th Place West <br />Address <br />Construct six unit apartment <br />19 <br />Public Wodia Pemitra <br />Bldg. Debt.• 84/13845 <br />Public World Fee S — <br />Total Fee <br />Leae Apo[ Foe Paid <br />Balance Due $ <br />Edmonds 98020 542-8054 <br />lily <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work -Draw to scale and note 0 Cenllowing as terllne of street <br />able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. <br />2. All work shall be performed in accordance With this permit and current City of Everett Design and Construclinn <br />Standards and Specifications. <br />before you dig. TOLL FREE NUMBER 1.800.424.555 <br />5. <br />3. Call Location Underground Service 48 hrs. <br />1,;'C'f� ee'vSI-Ac, r��7 PEe <br />stfi'tociC'n AiLA CJdiT� <br />1, <br />> <br />-,!i /l ,off Jn /8f <br />Approv d for Construction <br />Dale <br />FINAL INSPECTION <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8815 <br />S/T� .4'4,d N <br />9�/'fs 3z <br />W <br />Iwo <br />M <br />O <br />n <br />z <br />O <br />ACKNOWLEDGEMENT 01: CONDITIONS <br />The undersigned owner/applicant hereby agrees fo hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />_ Date <br />Signature of Appli ant <br />RTR ED BY THIS PERMIT <br />OH <br />OPAND THEREAFTER IS TO <br />BODAFATE PERMIT IS <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY GTOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />