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>� � ( 3 7 �' �(- <br />� APPliattion For <br />PUBLIC WORKS PERMIT <br />�Q 1 � 1p�p�16LIC WOR� DEPARTMENT <br />TO POSTING r`� .-_��3�AOC�,r51r259-8810 <br />0 <br />�8 1 A 1947 r �Q$og��„ � <br />TYPE OR PRINT ONLY ,.°'., -,i �..p; o� o ri � <br />CJ �ON M�~�ep � <br />M <br />Owner <br />.4pplicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if kncwn) <br />Mailing Address o. � <br />Date___ 3/28/96 <br />Public Works Permit k - I lfi� <br />Building Permit A 51230 <br />� � �c� orks Fee S �-C� <br />o .�� � <br />[� Q� CJ �O <br />b: rJ [� m <br />2ip <br />♦ :�i� <br />�� _� <br />Phone <br />' Attach (our (4) copies of plans for proposed work - Draw to scale and note ihe following if applicable: <br />•Pruperty Lines •Outline and dimensions of all existing and proposed stmctures on the lot •Existing and pmposed utililies <br />•Centerline of sireet •indicate North •SYiow any proposed grading changes •Show measurements <br />DO NOT WRI7E BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shali be made 24 hours in advance - phone 259-8810. <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 1-800-474-5555. <br />� 1���� c�r�'� w�� �f���! �-z��� �d� ��'� �, r.�e ��-� ¢ <br />, <br />S� <br />Ca <br />,�yi ,�o�J �� �,ti���-t� /.�. <br />� <br />.S,'c�eSec.��-� c; s ,ar,� ��f I �h <br />/ <br />l�o� �v�� ��rr c,��� -fc� d � ��c �, <br />� I, <br />�'��..��`�- �-/5/��- <br />Approvad for Construction ate <br />r� <br />Approved as Constructed <br />#�o� <br />� �� S�"�� e a <br />ACKNOVJIEDGEMENT OF CONDITIONS <br />The undersic�ned avner/applicant hereby agrees to hold and save hartnless <br />the City of Everelt from any and alt claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />lhe improvement nr other right-of-way use hereto appiied for and fu�iher agrzes <br />to remc�a�upon notice fmm the City and to replar.e public property <br />� <br />WORK AUTHORiZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF 7ATE PERMI7IS ISSUFD AYGD THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />