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������/f�C� � T� POSTING APR � 4 1996 publicWoekSPermi�• � <br /> / ' v <br /> Date G � qPPlication For APR � 0 1996 B�°9 °ep� • 2 <br /> r-� <br /> � PI;�LIC WORKS PERMIT P°°'"`"°`"=`0e . <br /> .o,�,��� $ i — <br /> O Less Anp�.Fee Paie �� <br /> O / �— <br /> 00� O O n � O fri �`� U7 [� Balance Due S� � `� <br /> Pfint of Type Onl� '�'O "' o o ni ra �a o ,o a <br /> r� c�r%, � o o � o .: c�i r�i -a <br /> .�+ f'7�tt w O N? O� t•? tn .t .-y .t <br /> �ui C.� +R O � � � � � <br />( � .-i +-� � N �1 y <br /> � �-, �, q�j/� W 9��j5 �y7-���� <br /> �- �t � �e. ,� 15 �i�S <br /> � C�.���8�� ""� i r' c: [� u�Q�Y ZiP Phone�_ <br /> Owner ,., � �� �+ -+ o n- <br /> \ O J_1U� 0 ~¢ O W � .�-iOC~i. 3 ~ �= <br />. (�� O 3F 6l 6. �]] ?L 3 � N W +� SC Q 2 (i c.l <br /> J licant Mailing Address City Zip Phone <br /> App' <br /> Describe Proposed Work ��� � � �� p��U/nK� �u�l`^��� — S <br /> W <br /> ProleclAddress(ifkno'+vn) ��e3� '9T� �� E � , <br /> � <br /> Attach(our(4)copies of plans tor proposed work• D�aw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ot street <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BEiOW THIS LINE /� <br /> PERMIT CONDITIONS � <br /> - 1.All calls for inspection shall be made 24 hre.in advance-phone 259•8810. <br /> 2.AII work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> . . Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> � ��, ,�r �,�pr�a�� ��.=s �"��'� 7-Z�- �o O <br /> � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> — less the City of Everett Irom any and all claims lor damages, costs. <br /> � ezpenses, or causes of action Ihat may arise because nf installation <br /> T� � and maintenance of the improvement or other right-ol-way use hereto <br /> applied for and furiher agrees to remove same upon notice from the <br /> Ap � ved for struction Dale �iry and to replace public properry damaged thereby. <br /> - � ' <br /> - '�� /� '� 3d I4,0 <br /> � . _ <br /> FI AL INSPECTION -' �� Dat S�9nature of Applic t Date <br /> Approved as Constructed <br /> WORK AUTHORI"LED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSD'cPARTMENT 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> � 3200CedarSireet BE DILIGENT�Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION, <br />