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� APPlication For — <br /> PUBLIC W�RKS PERMIT °ate_ _ 3i2si9' � <br /> PUBLIC WOFKS DEPARTMENT Public Works Permit tt ��(__�Z_ <br /> 3200 Cedar Street � <br /> Everett,WA 98207 259-8810 Buitding Permit# 54630 <br /> TYPE OR PRINT ONLY ? AUG 2 p 5�9R public Works Fee S_� <br /> � : �STING _ - <br /> MURPHY BUILDING CO 6135 SfiAVIEW AVE NW /12G SEAT'PLE 98107 789-0436 <br /> Owner Mailing Address City 2ip Phone <br /> BOB OR JOHN 789-0436 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Propused Work NGW HOUSG � <br /> I� <br /> � <br /> �// <br /> PROJECT ADDRESS(if known) 10516 7TH AVE SG LOT 3 SHORT PLAT 12-96 � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following if applicable: <br /> •Property Lines •Outline and dimensions of all existing and proposed siructures on the lot •Existing and proposed utllities O <br /> •Cen�edine cf street •Indicate Norih •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calis for insper � on shall be made 24 hours in advance - phone 259-8810. O <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ` <br /> �•_ <br /> V♦ <br /> ! '�. �,�r �n�bli< <nrnb , �ip�irn� .,d sit: jil u ,O <br /> ' I11�[:1�� III � �Iti�)cI'�IOII hYflCfl JII1�1 Afi �)�i 1PCIli?II �-�.b.1 fILU I'IRIII': .3-�.L �WU 1 dl�f: i-�.� UI UlC CI � <br /> ;i�,ii�nva[:, �\d<m ��,u�rul �Itim:il (coNt st�;ird to llii� pannit). llisp�i,ion s�stenis si�ould b: <br /> !�;;.I;tili.d lo fh:� :;urt�cr �eilli �ravel to alluw for o��eillo�s°. ('�II PuLlic R�orl::: lor.�n in:.p:;tioi� p ioi <br /> �n ('i��':.rlll�� �!"II('IP'� <br /> � <br /> � �xcess d,r� -k�M -�O�.,d�t�,� ex���vaf�or sh�i( �x ��I�+d -� <br /> ��� u� rovcd ��trn�� �'{-� r��;ev��v -�I (. <br /> � ��� , <br /> �� ���� � �� , � <br /> �� �`? - ✓' <br /> \� � � , �, 1119�1 <br /> .. �����; <br /> ACKNOWLEpGE' Ehl]VSF��(�VDITIONS <br /> �� 7�r� /'+�/� /���� The undersigned ownef<app4c�ntil��rebp'til���es to hold and save harmless <br /> �/ `�/`�� ihe City of Everett from aFy�aec��qn��Elalms for damages,costs,expenses,or <br /> causes of action ihat may a�i5� because of installation and main�enance of <br /> AppovedforConstruct n Date theimprovementorotherrighbot-wayuseheretoappliedforandfuriheragrees <br /> � �� ^� i to remove same upon notice fmm lhe City and to replace public pmperty <br /> � �� �� ���7 damaged thereby. <br /> FINAL INSPECTION Date ( <br /> Approved as Ccnstructed `� � � �// <br /> re of Applicant Dat� <br /> WORK AUTHORIZED BY THIS PERMIT MUS7 BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS E CILIGENTLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVEfi 90 DAYS UURATION. <br />