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Date_2,L]_4,cg7. <br />Application For <br />PUBL.IC V4�ORKS PERMIi <br />Pr�nt or Type Only <br />r=������� �vo,�s r�,:,m�� ., <br />91np Dep� c �].�Z�4Q5 _ <br />Po011c Warks Fcc <br />lolal Fee $ _ <br />LessAppL Fee Panl S _ <br />Bal.�n. � Due S _ <br />Brian D. Shaffer 19818 -�'tth pi SF nn hni i qam � qs.�_�q�� <br />Owner Mailing Address Cily Zip Phone <br />Oomer <br />Applican� Mailing Address ���ty <br />�escribe Proposed work L-shaped deck around office <br />Project Address (i( known) <br />Altech four (4) copies ol plans for proposed work - Draci to scale and note �he following as applicable: <br />• Property Lires <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing antl proposed Wilities <br />• Cen�edine of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDIlIONS <br />7. All calls for inspeclion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perinrmed in accordance wilh ihis permit and curreN City of Everell Design and Construc�ion <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />/� � �n f r��"' � <br />l� /' F � � <br />Approved lor Cons�ruclion <br />F�INAL INSPECTION <br />APnrovetl as ConsVucted <br />everell PUBLIC WORKS DEPARTMENT <br />�3200 CedarSUeet <br />Evered, WA9B201 <br />Phone:259�8810 <br />ACN;NOWLEDGEtdENT UF CONDITIONS <br />� <br />0 <br />� <br />� <br />O <br />a <br />__ The undersigned owner/aGPlicant hercby a�r�es to hold and �ave harm- <br />— less the City ol Everett from any and all claims tor damages, cosis, <br />expenses, or causes of action Ihat may arise because of installation <br />and maintenance of ihr, improvement or o�her right-of-way use hereto <br />applied for and further a9rees to remove same upon no6ce from the <br />Dale City and to replace Vublic property damaged ihereby. <br />Date <br />Signature of Applicant Date <br />WORK AUTHOal7_ED BY THIS PERMIT MUST BE STARTED WIiHIN <br />180 DAYS OF DATc PERMIT IS ISSUED ANCI THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TG COPdPLtTiON. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br />PROJEGT W[F 90 DAl'S DURATION. <br />