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Date "/ /" To POSTING Public Wo,l.PPrmn. 1 <br /> Application For Bldg Dela • �}'4 __ <br /> r <br /> PUBLIC WORKS PERMIT Publc waee.•Fee <br /> 1. lbixl rs <br /> i <br /> L' leu•DPS Fee PerC S <br /> O <br /> Print or Type Only <br /> cr <br /> Pd ^ M 90 X70 0 OO ur, <br /> .t M `MOM M p b� N 'O0 <br /> m <br /> M fi <br /> Lot/iX, W-A RgWk Wlk <br /> Owner Mailing Address a y City x npp�i r In Phone <br /> Applicant ae Mailing Address City Zip Phone <br /> Describe Proposed Work <br /> Uj <br /> Project Address(if known) 11117 (Ali <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes Cn <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE to <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259.8810. 0 <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.Call <br /> Location Underground Service 48 hrs.before you dig.TOLL <br /> FREE NUMBER 1.800.424.5555. <br /> �' I`IZtiN t,c�1�/1 001"'Wrl-1 101 j6't,b CiL -(rom 12;?4 f>4GVYt7 �r rl �,ir)�tt.�'Y.Xwt <br /> r <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> _ less the ^-„y of Everett from any and all claims for damages, costs. <br /> f I expenses, or causes of action that may ^ .se because or installation <br /> and maintunance of the improvement or other rightol-way use hereto <br /> Ap Quad to o ton --� atP applied for and further agrees to remove same upon notice from the <br /> � ` City and to replace public property damaged IherebY. <br /> FINAL INSPECTION Date S <br /> Approved as Constructed ,fligillature-o(AWrEcam D le <br /> IllPUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 320OCedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 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 />