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__ _. <br /> Date 9/zs/9i —�—�"�5 Pu�licWorksPermila �-S _ <br /> Applica�ion Fot BIdg.Oeo�.+ 91/277 <br /> PUBLIC WORKS 9ERMIT P°°'�°W°�k=F°a = <br /> Total Fee `S <br /> p�q / ' n_�� Less FppL Fea Paitl � <br /> T� b'fOt�����j:3 .� Balance�ue .S�_ <br /> Print or Type Only P J � Z 2 � p � <br /> James Olson 4215 SSth Ave NE Seattle 98105 742-2876 _ <br /> Owner Mai4ing Address City Zip Phone � <br /> Appiicant Mailing Address City ZiP Phone <br /> Describe Proposed Work Construct new 10 unit aDt. <br /> (SEPA 36-91) <br /> � <br /> Zz _ W <br /> l�h A�e Sc ``' � <br /> ProlectAddress(ifknown) � �. --�� -� ��"� <br /> Attach four(4) copies ot plans for proposed work- Draw to scale and note ihe following as applicable: ���-'-'�-��-����� - � <br /> • Pioperty Lines • Centerline of street _—- ��� --- � . <br /> • Outline and dimensions of all existing and • Indicate North - "- _ _ . i <br /> proposed structures on the lot • Show any proposed grading:,changes ��� _ , <br /> • Existing and proposed utilities • Show measurements :.,_�...,,.:-.,. � � <br /> • DO NOT WfiITE BELOW THIS LINE . l - O <br /> PERMITCONDITIONS � � <br /> � t.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. ��:,� -��- � q <br /> 2.All work shall be performed in accordance with this permit and wrrent Ciry of Everett Design and Construction ♦ <br /> � Standards and Specifications. � � �� � ��.. i <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. ��- �� � . <br /> � �.-P"- a�j�r �,...Q� � ,�-� �l�r�� /Z-2-9% O <br /> � I <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 from any and all claims fer damages, costs. <br /> � % expenses, or causes of action that may arise because of installation <br /> �. and main�enance o� �he impiovemen� or other right-of-way use hereto <br /> applied tor and further agreas to remove same upon notice Irom the <br /> Ap � ved f r��tru 1i . , Date City and to repla public property damaged ihereby. <br /> G �L= / <br /> : /` //�� � o1�J'�Z2 / �i<'c� <br /> INAL INSPECTIO � . � � Date �— J <br /> pproved as Constructed Signa� ot Applicant ate <br /> PUBLIC WORKS DEPARTMENT �(�K AUTHORIZED BY THIS PERMIT MUST BE ST RT WITHIN <br /> ��r� 3200CedarStreet /BO DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ���� � BE DILIGL"NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> �� Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•BB70 PROJECT OVER 90 DAYS DURATION. <br />