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Date s�� O� �yl� <br /> Pu�lic Woiks Permit e <br /> . Application Fo� eina.oep�.r <br /> PUBLIC WORKS PERMIT P�°;o,°FeCFaa � �o — - <br /> tess Fpo�Fee Paia 5 <br /> �— <br /> Print or Type Only o��,���o�� s �� <br /> _ w_ n_ Acxa >> 1823 37th Street E.Verett, WA 98201 <br /> Owner Mailing Atldress City Zip Phone <br /> W. D. Haaell 1823 37th Street, Et�erett, WA 98201 <br /> Applicant Mailing Address ��� <br /> Y ZiP Phone <br /> Describe Proposed Work _ �etaining wall 1823 37th STteet� Everett� WA 98201 <br /> .,l�?r�/� //U /1 � W G�/` Q�,�S '� <br /> _ �7��L�C'c-�i' c�/J'T/�_�c Tf�in�/�G c�Jfr.CL 1 w <br /> Project Address(if known) �l/ ��7 J��— � <br /> Altach four(4) copies of plans for propo5ed work- Draw to scale and note the following as applicable: <br /> � <br /> w Property Lines • Cenlerline of street � <br /> • Outlina ard dimensions of all existing and • Ir.dicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All cal;s for inspection shall 6e made 24 hrs. in advance- phone 259•881 5. <br /> 2. All work shall be performed i�i accordance with this permit and current City ot Everett Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. 70LL FREE NUMDER 1-800•424•5555. <br /> /� �i�L�CF_ ��LOG-4/��� ��CiTj jiY� C.�'/ GG `'G-/� � <br /> ��/�itl�J��� _�c7�o , � <br /> s, /��=•'e �5T/r%/cTlfiE'�9G �c�S'/",�1� �SJ'Oc/i9i2�' //IJC', � <br /> /`�Gl� C/>j9iZ�0 ��S/�..�� � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> �/- less the City of Everetl from any and aL claims lor damages. costs, <br /> y� expenses, or causes of action that may arise because of installation <br /> /� � � �c-�i and maintenance of the improvement rr other righbof�way use hereto <br />� � applied for and luriher agrees to remove sam� upu� nc!ir.e Irom the <br /> broved lor on uClion � Date City and to re I ce pubhc p .perty damagecJlhereby. <br /> � �sZY-�6 , � <br /> r <br /> i <br /> INAL INSPECTION Dale �� � .� / �-F'- � i � <br /> Approved as Constructed � nature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTME�iT WORK AUTHORIZED BY THIS PER IT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISS ED AND THEREAFTER IS 70 <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPL5TION. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />