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Date�H/92 PuEbc Works Pa�mit a <br /> Application For <br /> eiao.oeot•. 36950 <br /> PUBLIC WORKS PERMIT PUOTo�feeFee S <br /> Lev Aoo�Fee Pa�a $ <br /> Ba�ance Duo S <br /> Print or Type Only <br /> Lois Lowry 12343 Hiram P1 NE Seattle. . -�A1�S ��S_mno <br /> Owner Mailing Address C��y Zip Phone <br /> Dale Johnson 775-8178 <br /> Applicant Mailing Address Cily ZiP Phone <br /> Describe Proposed Work 2._,a�*a�= ^aa:«:.... «.. �.. _ <br /> � W <br /> Projecl Address(if known) 2117 — Sth St. � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of slreet � <br /> • Cutline 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 measarements � <br /> DO NOT WRITE BELOW THIS L�NE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All 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•800-4245555. � <br /> , �/ // O <br /> �iJ�-�cvrrel�-�i�-i,,,.F� /�.r�,Ec y�-c.� �/ <br /> E � � � <br /> , <br /> �6 I N <br /> U -� -� ZJ � <br /> a <br /> ACKNOWIEDGEMENT OF CUNDITIONS <br /> The undersigned owner/applicant hereby aprees to hold and save harm- <br /> less the City of Everett irom any and all claims tor damages, costs, <br /> expenses, or causes of actio� that may arise because of installation <br /> and maintenance of the impr�vement or other righbobway use hereto <br /> applied for and further agre��s to remove same upon notice irom the <br /> Approved for Consiruction Dale City and to replace public property damsced thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Dale <br /> PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ��r� 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSU�D AND THEREA.FTER IS TO <br /> ��r Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETIOh. THIS PERMIT MAY BE <br /> �� Phone:259�BB10 CANCELLED BY THE CITY UPON A�JY PiTOPPAGE OF WOAK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />