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Date -31" f rt POSTING AUG 0 9 1996 PUb11CWpterPeflnit0 <br /> Application For aid, Dept e_ <br /> PUBLIC WORKS PERMIT Pupe0Worxe Fee <br /> Ts <br /> � i.i Fee <br /> w Appl Fee Pud s <br /> Print or Type Only ca Due S _ <br /> 'MACO L°,9uJblpfC 1 eeieniW 4VISde11ev1_ vv I�o> c// 9sOiZ. Vie/-aay_ <br /> Owner Mailing Address City Zip Phone <br /> Lei hna, 1&-iflvr AA fires W L•+!¢ (teWAILC 992S61 3.?V_0676 <br /> Applicant a Mailing Address City 1-Zip Phone <br /> Describe Proposed Work S12"dar y 4e4 l oor S fx t./,Pm /'r, tete Fit, PA-g le <br /> -V ezr i It l rte/( Gr7t ftl <br /> W <br /> Project Address fit known) <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: tt� <br /> • Property Lines • Centerline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate North v+ <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELO!' THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.In advance•phone 259.9810. <br /> 2.All work shall be performed in accordance with this permit and current Gi;v of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> 93 <br /> JAN 311995 Q <br /> .................................... a <br /> CITY OF EVERETT thee <br /> Building Division <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs. <br /> expenses. or causes of action that may arise because of Installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> ` applied for and further agrees to remove same upon notice from the <br /> Approv for Co ruc Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date Signature <br /> •��c��si <br /> Approved as Constructed Signature of A icant Date <br /> IVPUBLICWCRKS DEPARTMENT WORK AUTHORIZED By THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everett. da 98201 tree BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phonet2 A810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />