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i _ � <br /> �Crr��� APPiication For <br /> PUBLIC WORKS PERMIT Date_ <br /> PUBLIC WORKS DEPARTMENT Public Works Permil N _��/J_/_�— <br /> 3200 Cedar Street � � <br /> Everett,WA 98201 259-8870 Building Permit q <br /> TYPEORPRINTONLY 9O POSTINV MA�� �^ <br /> Public Works Fee$ �op g <br /> Si�r� � <br /> Lr/2vJro.a. C So�T�vir' �225' '�µ.�U((1 �1u�. 9BZ�S Z�fO'/Zs/ <br /> —�er Maili Address City Zip Phone <br /> cSrltG�r/ L�y�-�.r�/�7� /"�Ln• f'if /a� ��Q3'� gZZ 98Sy <br /> Applicant M'ailing Address City Zip Phone <br /> Describe Proposed Work ,�t7''� �t.�2��L��� � � <br /> Ob-23-97 3:55PM � <br /> OTF�R 295.13 w <br /> �/� <br /> PROJECT ADDRESS(if known) � � E • CHEFC 295y13 <br /> Attach four(4)copies of plans lor proposed work-Draw to scale and note Ihe tollowing if applicable: i� <br /> •Property Lines •Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed ulilities O � <br /> •Cenierline of street •Indicate North •Show any proposed grading changes •Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. AII calls for inspection 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 Citpp{�tt$�and <br /> Construction Standards and Specifications. N 53795 <br /> 3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE Nq{]p�q�1�4A�-5555. � <br /> '1 /� � � / SURCf1AFGE 4.50 <br /> �f• /�� �lu--s lu,..f N 9419 � <br /> IJATE° 260.00 O <br /> R 31149 <br /> SEIJER 70.00 /� <br /> UTILITY OEV �� <br /> 32526.00 <br /> BOND 111 1469.60 <br /> H 4420 <br /> WATER 105.00 <br /> k 97183 <br /> FW/ REVIEW <br /> 225.31 <br /> PW/ INSP. <br /> 1408.20 <br /> TOTAL 38249.71 <br /> GHE 38249.71 <br /> A OR 574 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ox�ner/applicant hereby agrees to hold and save harmless <br /> ` � �' � the Ciry of Everett lrom any and all claims for damages,costs,expenses,or <br /> o tor str ion Date causes of action that may arise because of installation and maintenance of <br /> ihe improvement or other right-of-way use hereto applied for and further agrees <br /> � � . to remove same upon notice from the City and to replace public property <br /> �,� � ��t� � _� �- dama9edthereby. <br /> FINAL INSPECTIUN Dale /� r � �— �— � <br /> Appwved as Constructed . 1 z?�- <br /> li <br /> natu e of Applican� Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE P'cRMIT IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE CF WORK ON THIS PROJECT OVER 9D DAYS DURATION. <br />