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Date--4/;_7/,r Pu^ucW°ruPermu• ��}��J <br /> aids Door o 90/25666 <br /> Application For <br /> PUBLIC WORKS PERMIT `°^°°Works I'" <br /> uirro, <br /> TMN fee s <br /> x hJ Leu APP,fee Paid S _ <br /> A W H Print or Type Only F aeunceDue s ?O <br /> y TO PO�TING_i� A( <br /> HFranssen/Vierthaler 5821 Central Dr. Everett 98204 745-6918 __- <br /> H :11 Owner Mailing Address City Zip Phone <br /> CA ii owner <br /> H <br /> ZO Applicant Mailing Address City Zip Phone <br /> H t7 <br /> O ~ ty New dePleX <br /> H L21 O Describe Proposed Werk -- <br /> a- n <br /> z <br /> 9 3 <br /> t z1 � 1 <br /> 7G 1-1't ST 5E <br /> F" (Lot 3 of SP 25-89) / <br /> C] t7 LA Protect Add- ,,known) J�w'"��"a+�\ <br /> Attach f: ..rift copies of plans for proposed work• Draw to scale and note the following as applicable (I BLDG OPINIONf . V) <br /> H 1-3 CAIWATER $130f1�• Property Linea • Centerline of street .00� <br /> •Outline a.id dimensions of all esisling and • Indicate North <br /> proposed structures on the lot • Show any proposed gradl <br /> • Existing and proposed utilities • Show measurements 00 �yia <br /> DO NOT WRITE BELOW THIS LINE DRVW 1120,58 00 O <br /> PERMIT CONDITIONS DIED( !12117. <br /> ''f�. 1.All calls for Inspection shall be made 24 hie.In advance•phone 259-8810. <br /> �.3 2.All work shall be performed In accordance with this permit and current City of Everett Design and Construction r/ <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 his,before you dig.TOLL FREE N UMBE R 1.800.424.5555. Z <br /> O <br /> �� 0 <br /> 0, <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, costa <br /> expenses, or causes of action that may arise because of Installation <br /> ire o -.A— 17--C)0 end malntena 1 the improvement or other right-ol•way use hereto <br /> apvTplied r a d 1 Ther agrees to remove same upon notice from the <br /> Approved for Const Date City a r pl public property damaged therapy. <br /> FINAL INSPECTION Date <br /> Approved as Constructed 51 nature of Applicant Italia <br /> WORK AUTHORIZED BY THIS PERMIT UST BE STARTED WITHIN <br /> W <br /> PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISUUED AND THEREAFTER IS TO <br /> 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> le Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:2598810 PROJECT OVER 90 DAYS DURATION. <br />