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�■rws <br /> J ^ ��^2�� S� / <br /> DBte 3-12-92 Pu��m Woihs Permlt• qZ- ( �� <br /> Application For � eioo�oePi.• 35953 <br /> PU�LIC WORKS PERMIT PubLCWarksFec - <br /> iola�Fee g <br /> � Less AO��.fee Paia S <br /> Print or Type Only , ea���«o�� S z-� <br /> ' ; . <br /> r • <br /> Willizun Belshaw 2111 Rucker Ave � Everett wa 9R�47 � �Sa-is�v <br /> Owner Mailing Address, ;.� City � � � �Zip Phone <br /> � � , i � i <br /> i , <br /> Owner . �. � � . ... .. . .. .. .. <br /> Applicant Mailiny Address City Zip Phone <br /> Describe Proposed Work C'-onstrnnt na.., c;n.,l a f�m;i.. .-��y��16e ! <br /> w <br /> Project Address�it known� 1414 - 12th St. � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the folWwing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existinu and • Indicate North <br /> proposed siructures on ihe lot • Show any proposed 9rading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BEIJW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance-phcne 259•881 O. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Sarvice 48 hrs.betore you dig.70LL FREE NUMBER 1•80U•424•5555. � <br /> � , N 0 'f�e.�ve���..� -�o i2�t�t s� - O t� s �� P�.��c.i N U O <br /> MvsT �.c_c.EsS ,�s.,t�e� . <br /> S, LotJ�JCLT �p�urJ �Pc'�UTS -T'o S i D� S��_, �. <br /> V♦ <br /> O <br /> �c ►� � � a <br /> r c P �' <br /> � � !MENT OF CONDITIONS <br /> i <br /> / nt hereby agrees to hold and save harm- <br /> �r L ��C �"�� my and all claims for damages, costs. <br /> n „ �� _ / thai may arise because ol ;nstatla�ion <br /> 4 � � 1 �/ �� / emenl or other righPof�way use hereto <br /> � A�A u � �7� <br /> Aporovetl for Construction �`�/ C�� � lo remove same upon notice trom the <br /> ��M OAy'S �- 7- 3 �rt dzmaged thereby. <br /> FINAL INSPE(;TION � � � • � � .l <br /> Approved as Consiructed � , Date <br /> � PERMIT MUST 8E STARTED WITHIN <br /> PUBLIC6VORKSDEI a_oeo<:v�eu�neacesi,,,asrb��ni.�c IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CedarStreet i COMPLETION. THIS PERMIT MAY 9E �+- <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS� / <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />