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DateXXH 10-5-92 TO rn X71%1 q/Lh/�3 E <br /> - G___ rueec woae Pe.mn. —/ V— <br /> Ap(ply1lc�yyil���1n'r oido o.Pt •_ C-382 <br /> PUBLIC W�y, "`V rG �� PuLi¢Work.ree <br /> IIILLLJJJIII V Tol•I Fee s <br /> ucr2 '3 <br /> 1992 �� leu APPS ree Pell S <br /> Print or Type Only -7. JJL 94111nce13ue s — <br /> CITY OF EVERETT <br /> Bev Carmen Box 3598 EVcWLq!n9 DiVlsi0rAB203 259-1166 <br /> Owner Mailing Address City Zip Phone <br /> Millco Const. Box 249 Lynden, WA 98264 354-5044 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 00nstl=t new CFR <br /> Project Address(if known) 617 - 58th PL SE _ LU <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines <br /> • Outline and dimensions of all existing and • Centerline of street <br /> • Indicate North <br /> Proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for Inspection shall be made 24 hrs.In advance-phone 259.8810. <br /> 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> q. F; II Gravel space a � e..el c�{yal 4=0 ot- Z <br /> khan outside around level — Pf-o.vide :=>uSI�. fve 0 <br /> dratnay� .�, Cjrn crawl SPzce , <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> / The undersigned owner/applicant hereby agrees to hold and save harm- <br /> .. r less the City of Everett from any and all claims for damages, costs. <br /> expenses. or causes of action that <br /> me may arise because of Installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> App oved for Construction applied for and lu rther agrees to remove same upon notice from the <br /> Date 6igna <br /> o replace public properly damaged thereby. <br /> 3 <br /> FINAL INSPECTION Date <br /> Approved as Constructed of AppantDate <br /> PUBLIC WORKS DEPARTMENT THO ZED BY THIS PERMIT M ST BES RTED WITHIN <br /> 3203 Cedar Street OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 90201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:2598810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />