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H Cl) <br />M r it <br />JD <br />C: H <br />9 '3 !n <br />d H <br />ro O <br />H �1 <br />oxo <br />ng H r>d <br />N H <br />11 O <br />HC <br />W <br />n0 <br />z�, <br />T <br />z <br />1H <br />gL7 <br />N <br />0 Cr N <br />�M� <br />HOIn <br />ttn <br />%sa goo <br />Date <br />nppllCDllon For <br />PUBIC WORDS PERMIT <br />Print or Type Only <br />Pubic WOrkk P11.P11 9t 1to <br />81" Door <br />Publcwort{Feo a <br />TPlal FPx <br />LekF kPPI Fe.P\Id a <br />B�IxnCP Due a _ `�— <br />Help Lloyd /3zvFs i3�'"�v� krklreitj 9ko i sal-,�zs — -- <br />wne� Mailing Address City 7.� Phone <br />Applicant Mailing Address City Zip Phone <br />i. <br />Describe Proposed Work 41C/4J 5!1-4tlp- <br />Project Address lit known) 1-7 — -TS-Ul St SE -. <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 />• Outllne and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed guiding changes <br />• Existing and proposed utilities • Show measurements 05/08l91 1.241 M 000AN6891 <br />DO NOT WRITE BELOW THIS LINE #00026752 <br />PERMIT CONDITIONS BLDG $590.00 <br />1. All calls for Inspection shalt be made 24 hrs, in advance - phone 259-8810. PLEG $55. 00 <br />2. All work shall be performed In accordance with this permit and current City of Everett Des tf EL" Conslr";;0 <br />Standards and Specifications.' <br />3, Cell Location Underground Service 48 hra before you dig. TOLL FREE NIJra BER 1.800• C 55.510.00 <br />11000G7223 <br />WATER 1150.00 <br />400028249 <br />SEWER $3000 <br />1171-5 $550:00 <br />CHECK $1569.50 <br />A mcic s <br />4-15 -s1 <br />Approved for Costruuccill <br />Dale <br />l�nZ/ <br />- -1'8- S/ <br />FINAL INSPECTION <br />Dale <br />Approved as Constructed <br />rvereh <br />PUBLIC WORKS DEPARTMENT <br />Ever Ceder Street <br />Everett WA 882018201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />11- <br />ryi <br />W <br />00 <br />z <br />0 <br />11Fm <br />Vj <br />0 <br />IL <br />The undersigned cwner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages. cost& <br />expenses, or causes of action that may arise because of installation <br />end maintenance of the Improvement or other right•ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />C and to <br />replace public, pr erty damaged thereby. <br />Slgnalure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE SrARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY r <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON <br />PROJECT OVER 90 DAYS DURATION <br />