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l)8t©� PYb11C Works Pe mil e <br /> 86 - ysz <br /> �T Application For Bldg Dept e <br /> PUBLIC WORKS PERMIT P°°to181Fte . — <br /> Liuui App].Fee Pud Q <br /> §_. <br /> aebnce Due 6 <br /> Print or Type Only <br /> JFM Constsruction 1231 South Direc'.or Avenue Seattle, WA 98108 763-0320 <br /> Owner Malting Address City Zip Phone <br /> scum <br /> Applicant Meiling Address City Zip Phone <br /> Describe Proposed Work Congtirurt Four—P1cx <br /> W <br /> Protect Address fit known) 6007 Broadway Avenue, Everett 3 <br /> Attach four(4)copies of plans for proposed work•Draw to scale and note the following as applicable: rrtrrltttM <br /> • Property Lines • Centerl.•to of street ♦^ <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 wA <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 259-8815. ash <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 his. before you dig.TOLL FREE NUMBER 1.800.424.5555. awn <br /> O <br /> O <br /> a <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 applied <br /> for maintenance of the improvement or v other right-of-wayu, notice <br /> use hereto <br /> applied for and further agrees to remove same upon nohce from the <br /> Approved for Construction ate City and to replace public property damaged thereby. <br /> 167 (,4uA;bIl�lP <br /> FINAL INSPECTIONDale <br /> Approved as Constructed Signature of Applicant Date <br /> evnrett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISE'IED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> D <br /> Phone: 259.8815 PROJECT OVER 90 DAYS DURATION. <br />