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Pupl¢\4orkn Permlt• y � � <br /> 4-8—S2 <br /> D8t8 eiaa o�u� . 469F�4 — <br /> Application For <br /> PUBLIC WORKS PERMIT �°°To�aFae"° a �'7O — <br /> / Less Roo�Fee Peia S q <br /> Buance oua S Z� <br /> Print or Type Only <br /> Lisbon Development 626 128th St SW 1llOG Eeer tt 9820R 743-5566 <br /> Owner <br /> MaiNng Address City Zip Phone <br /> Architects NW 18915 142nd NE N100 Wo dinville 9 G72 4 -4?00 A5046 Jeffrey deRoulet <br /> ppplicant <br /> Mailing Address Cit Zip Pnone <br /> Describe Proposed Work new conetruc[ion office arehou <br /> � <br /> W <br /> 303 � � <br /> Project Address(if kno�vn) � <br /> � <br /> Attach lour(4)copies of plans for proposed wo • Dr lo,sc le an e thcl ��lo as applicable: � <br /> • Property Lines • Center ine of street <br /> • Outline and dimensions of all exist g �d • �ndicale North <br /> propos�tl structures the lot /�� • Show any proposed grading changes <br /> • Existing and proposed u ' s � � Show measurements M <br /> W <br /> D T E BELOW THIS LINE O <br /> ' PERMIT CONDITIONS � � <br /> t.4��caus for�rmpection ahe��be ede �n nce-phona 259-8810. <br /> � 2.All work aheli be pedormed In ccordance i ia permit and wrrent City ot EvereU Uesign and Construction <br /> Staadards end Specfflcatlon � <br /> 3.Cell Locetion Underground ervice 48 hra.be re you dtB•TOLL FREE NUMBER 1•800-4245555. <br /> �, ��,�- �p ,,—t � /Grv.l �/�r f��� v -l J-`� Z O <br /> / � <br /> .S l.c+z��o�sca - � L / /I/ � rr�-�� '.. <br /> �uM�s a�iri� i/��r+ ���if-of- �r>vsf �d�. � <br /> ,��, d, � Q <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owneVapplicant hereby agrees to hold and save harm- <br /> � � less the City of Everett Irom any and all claims for dameges. costs, <br /> � ezpenses, or causes of action that may arise because ot installation <br /> / � / and meintenance of ihe improvement or olher right•oFway use herelo <br /> applied lor and furiher agrees to remove same upon notice from the <br /> pp ov lor Co ru ' ate ity and to replace public properly damaged ihereby. <br /> i <br /> FINAI INSPECTION Date Date <br /> Signature of Applicant <br /> Approved as Constructed WORK AUTHORI2ED dY THIS PERMIT MUST BE S'ARTED WITHIN <br /> � PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO .. <br /> 3200 Cedar Street BE DILIG'cNTLY PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Everett,WA 987.01 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS .. <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />