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a <br /> 1-30Date 9/13/91 M-(p-2$ S Pub,mWorM.Pum.• 21 4 <br /> Application For eidg OsPI •.�27Ji09 — <br /> b PWXIC WORKS PERMIT P°°lkw°M °•• . <br /> •� <br /> In lgr•I F.I. } <br /> La••coot tee Paid !< ^pY <br /> _Balance Due f 'i <br /> Print or Type Only: u r9 <br /> Q H TO POSTING 11 —z <br /> Cie H r i <br /> z ° 116th St SE Everett 98208 337-7153 <br /> Qy Owner Meiling Address City Zip Phone <br /> n` O Applicant Mailing Address City Zip Phone <br /> H <br /> z <br /> H y Describe Proposed Work ruslid tr acv house <br /> SN <br /> H <br /> yy <br /> CA W <br /> Oy <br /> Protect Address(If known) 325 60th at Sl. <br /> Attach lour 14)copies of pians for proposed work-Draw to scale and note the following as applicable: r_ <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 �A <br /> DO NOT WRITE BELOW THIS LINE WO <br /> PERMIT CONDITIONS <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 Ihla permit and current City of Everett Design and Cons;ruetlon <br /> Standards and Specifications. <br /> 3,Cell Location Underground Service 48 his.before you dig.TOLL FREE NUMBER 1 800.424.5555. Z <br /> J O <br /> N <br /> O <br /> [L <br /> awlIND <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 /> C and maintenance of the Improvement or other right-of-way use hereto y <br /> ��L��`► • 1 �L+�-- applied for and further agrees to remove same upon notice from the <br /> AppfbviTd for Conslru Ion Dale City and to replace public property damaged Thereby. <br /> FINAL INSPECTION ��J Date <br /> Approved as Constructed Signature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street BE DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 49L Everest WA 80201 BE DILIGENTLY <br /> Y P'1RSUE0 TO COMPLETION.THIS PERMIT MAY BE <br /> 299.9020 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Ph cell <br /> PROJECT OVER 90 DAYS DURATION. <br />