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� <br />TYPE OR PRINT ONLY <br />Owner <br />AppAcant <br />PUBLIC �ORKS PERMIT <br />Describe Proposnd Work _ <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cadar Street <br />Everetl, WA 98201 259•8810 <br />D <br />�' <br />Publ{c Nbrks Pertnit N <br />Building Pertnit N _ <br />Puhlk: WnAts Fee f <br />Plan Chtek No: C 516BB �"�—�S82X"" `"` — <br />1►ppllcat.Dat�: 03(31 97 <br />Job 11ddr�t aoi �►r. RSON BLVD <br />O►itl�ii 611fiNON BRUCE/HALLSY Phc.`e <br />T�n�nts <br />Proposed U��i SIN6LE RAMILY RESIDBHCS <br />Dr�o. of Worke <br />MDITION AND RElIODHL (IAT C6ATIFICATION pho� <br />iB-96) r <br />OFFICS SST JOB <br />APPAVD FOA PBRMIT: DATS_/_/_ 8Y <br />Attach fuur (4) copies oi plans for pioposed work - Draw to scale and nate the following N eppllcaWe: <br />'Propeny Lines 'Outline and dimnnsions ot ell ezisting and proposed structures on tM bt •Fxisting and propoeed utilitks <br />'Canterline of slreet 'Indicate North •Show any proposed preding changes �Snow� meesuraments <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this pertnit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-B566. <br />�� {��bl�� V�orks <br />Appioved Por ConsWction Date <br />FINAL INSPECTION Date <br />P,pproved as Constructed <br />p�rm� Rc���v�c�� <br />� f�,�l <br />� <br />O <br />♦�� <br />VI <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDIT70NS <br />The undersigned ��wner/applicant hereby agrees to hold and seve hartnlese <br />the Ctty ot Everett from eny and ell claima fa damagee, costa, expensee, a <br />wuses of eetlon that may arisa beeauee of Inatallatlon end maintenance of <br />tha improvertxnt or other ripM-ol-way uee hareto applied for and furtlror apeees <br />to romove same upon rwtice fiom the Cily antl to replace pubiic propxty <br />damaged tMxeby. <br />Signature of Applicant Date <br />WORK AUTHORI2E0 BY THIS PERMIT MUST BE STARTED WI7HIN iQ0 DI1YS OF DATE PERMR IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELtED BY THE CITY UPON ANY STOPPAOE OF WORK ON THIS PROJECT OVER 90 DAYS WRATION. <br />