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��� <br />p�x <br />9Hy <br />r <br />y H <br />�C C] <br />H� <br />�H� <br />(q H <br />x <br />��d <br />��g <br />�1] Y �] <br />t�y� <br />HH <br />8 �' <br />�e� <br />��� <br />HOtn <br />I '' <br />er <br />Date 3 24 2 <br />� <br />Appliwtion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PupM1c Wmks Pmmi� • <br />em� oco� • <br />Puol¢ worxs Fee g <br />i0tal Fee <br />LessApoL Fee PaiO $ <br />BalancaDue g <br />ALVIN SORENSEN 1311 52ND EVERETT 98203 252-6544 <br />Owner Mailing Address City Zip Phone <br />ROBERT dACK <br />Applicant <br />Describe Proposed Work <br />Project Address pf known) <br />659-7384 <br />Mailing <br />NEW 340SF CARPORT <br />1311 52ND <br />City Zip <br />Atlach four (4) copies of plans for proposed work � Draw to scale antl note the following as applicable: <br />• PwFerty Lines • Centedine of street <br />• Outline and dimensions of all ezistin9 and • Indicale Norih <br />proposed structures on ihe lot • Show any proposed c�rading changes <br />• Existing and proposed utilities • Show mezsuremenls <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be pedormed in accordar ^e with this permit and current City ol Everett Design and Consiruclion <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FHEE NUMBER 1-800•424•5555. <br />�.,.� �.. <br />��1/��L��� /�����Z�'�n J <br />APProvad for Construction Date <br />FItJAL INSPECTION <br />Approved as Consiructed <br />�PUBLICWORKSDEPARTMENT <br />,��3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />Datc <br />i � <br />i' �'� <br />�� �r�('"� / `C f-i. ( � �� <br />�� <br />�- ��, .�z <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersi9ned owneVapplicant hereby a9rees to hold and save harm- <br />less ihe Gry ol Everett irom any and all claims for damac�es, costs. <br />exper.ses, or causes ol action ihat may arise because ol installalion <br />and maintenance of the improvement or other righ4of�way use hereto <br />applied lor and further agrees to reriove same upon nolice Irom the <br />City and to replace public Groperty damac�ed therehy. <br />Signature ol ApP�icant uaie <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEI.LEI� BY THE CITY UPON ANY SiOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />