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Date �-$-91 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Workn Permit • <br />BttleDePts 91�z�Z�z <br />Pu�llc Worka Fea <br />iolal Fee s <br />Les� AOPI. Feo Paid $ <br />Balance �ue 5 <br />Robert Bonn 832 52nd St Everett id9 98203 252-9345 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Appiicant <br />Mailing Addres: <br />oescribe Proposed Work Residential addition <br />Project Address (if known) <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Qraw to scale and note the following as applicable: <br />• Prcperty Lines • Centerline of street <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall t• made 24 hrs. in advance • phone 259•881 O. <br />2. All work shall be pertormed i�i �.ccordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call L��cation Underground Service 48 hrs. before you dig. TOLL PREE NJMBER 1-800•424-5555. <br />� i � i �+ <br />L ��-CC 4_ ��- �c7��Y I�C'.;! />t � f � �i9-/'� � .� ( � C-C.�2c:-C� <br />0 <br />Approved for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />Date <br />Date <br />�,/�c-�- <br />?-9-�/ <br />ACKIJOWL.EDGGMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City ot Ever=tt from any and all claims for damages, costs. <br />expenses, or causes of action ihat may arise ber.ause of installation <br />and maintenance of the improvement or other right-ol-way use herett� <br />applieA lor and further agrees lo remove same upon notice trom th!: <br />City and to replace public property damaged thereby. <br />ure of Applicant <br />Date <br />PUBLICWORKSDEPARTM1IENT WORK AU'fHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />�A���3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �'O <br />Evarett, WA 98201 9E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 13E <br />Phone: 259-B8t0 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThIIS <br />PROJECT OVER 90 DAYS DURATION. <br />