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� ApPlication For � ,' " 7 a�-Cl� <br /> ��;�. PUBLIC WORKS PERMIT oate_ 9/16/97 _ __ <br /> �" � <br /> PUBLIC WORKS DEPARTMENT Public Works Pzrmit p __�_��'v� <br /> 3200 Cedar Street <br /> Everett,WA g8201 259-6810 <br /> Building Permit a <br /> •nC�'��� MAY 3 0 2004 — ����`� <br /> 1'PE OR PRINT ONLY Public Works Fee S� T <br /> GEORGE RANERIS 1812 HtiWITT AVE (PO BX 1008) EVERETT 98201 425-347-1542 <br /> Owner Mailing Address Cit <br /> Y ZiP Phone <br /> CONTACT: HAL JENSGN (PGRTEGT ENGINEERING) 252-7233 <br /> Applicant Mailing Address Cit <br /> Y ZiP Phone <br /> Describe Proposed Work � <br /> U9=:'�-97 9:4?i?i1 <br /> � 97301. 1._ <br /> cfi ::�2,Oi; �� <br /> — r t.�i kULJ ♦�/� <br /> 487.6<' V♦ <br /> 'r'4./iiv".;'r' 3047.GG <br /> PROJECTADDRESS (if known) 11419 19TH AVE SE i OTAL 37;;7,�'� <br /> Attach four(4)copies of plans for proposed work-Draw lo scale and note the fo!lowing i(applicable ���L`��-' ���A' <br /> •Property Lines •Outline and dimensions of all existing and proposed strucWres on the lot •Existing and proposed util�ities� r ' <br /> •Centedine af sireet •Indicate NoAh •Sliow any proposed grading changes •Show measuremenis �� <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: � <br /> 1. All calls for Inspection sfiall be made 24 hours in advance - phone 259-8810. � � <br /> 2. All work shall be performed in accurdance with this permit and current City of Everett Design and � 1 I <br /> Construction Standards and Specifications. �/ <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � /�� �,�,��2��'�j ���:ff�c�"' e�l�iZ� � <br /> ��/� a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> �% _ Tha undersigned ownedapplicant hereby ag�ees to holJ and save harmless <br /> �-� the City of Everett from any and all claims for damages,cosis,experses,or <br /> e �� causes of action ihat may arise because of installation and maintenance of <br /> App ed lor Constmr.� � the improvement orother nyh�-ol-w.ry use hereto applied for and furiher agrees <br /> `- / 'o remove sam= u on natice <br /> `/ � � P (rom the City and to replace public property <br /> \ E' { ti .(�'��r+��- �,z _ _� ".� damagedthereby. <br /> � <br /> FINAL INSP[CTION Date <br /> Approved as Consiructed <br /> � �z "l <br /> S n t Ap hc t Da e <br /> N'OFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PUflSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF V✓ORK ON THIS PROJcCT OVER 90 DAYS DURATION. <br />