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�ace 2-24-92 <br />Application For <br />PUBLIC WORKS PERMIT � <br />/ /r�l <br />�� <br />Print or Type Only <br />PuoOc Wor4� Permit e <br />eieq.U.ou 99/'i5'i71 <br />PubiKWorx�Fea s <br />Tot�l Fea <br />Lo� Aool F�e P�iE S <br />e.i.��. o�. s <br />Susan Kramer 5515 Wetmore Ave Everett 98201 353-8789 <br />Owner MaiNng Address City Zip Phone <br />Owner <br />Appiieant Mailing ACdress City Zip Phone <br />Describe Proposed Work Addition <br />Proleet Address (if known) <br />Attech four (4) copies ol plans for proposed work • Draw to scale and nofe the following as applicable: <br />• Property Lines <br />• Outline and dimensiona of all existing and <br />proposed structures on the lot <br />• Exiating anC proposed utilities <br />• Centedine of streel <br />• Indicate North <br />• Show eny propor.ed grading changes <br />• ShOw m088Uf@f1lBflf3 <br />PERMIT CONDITIONS <br />1. All calls for inapaction shell be made 24 hra. in advance • phone 259•8810. <br />2. All work ahell be peAormed in eccordence with this parmit and curtent City of Evereti �esign and Construction <br />Standarda and Specifications. - <br />3. Call Location Underground Service 48 hrs. betore you dig. TOIL FREE NUMBER 1•800�424-5555. � <br />��. �C,�G+��[v-�cxr...,i'�,�7�` /�l�.uc•u� <br />�`. ��%'c <br />� L%Q/l.�Gu'u.� )2C[�-a� �er✓i.e. ��- � �� �?...-'-c':�P.�- <br />7 / lv.�� <br />i <br />�y�, yu��� � ��i+� )�-,,.;.��.�: C...,-�1.' .. -�z.:.:-..�- c��"� , <br />/ +- <br />Approved for Construction <br />�INAL INSPECTION <br />Appraved as Constructed <br />��k��� PUBLIC WORKS DEPARTMENT <br />�_ 3200 CeCar Slreet <br />Everet4 WA 98201 <br />Phone:259�BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The untlersigned owner/applicant hereby agrees to hoid and save harm• <br />less the City of Everett from any and all claims for damagea costs. <br />e■penses, or causes ol action that may arise because of installation <br />and maintenance ol the improvement or other right•of•way use herelo <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged theretry. <br />Siqnature of Applicant ua�e <br />WORK AUTHORIZED BY THIS PERMIT MUST B[ STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEii IS Tp <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />oqn IGrr nlrco n� nnVS f111RGTInN <br />