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- _ <br />, ,.,,<�rr � , , - - >: �' <br />( <br />Date ,/�S/G!1 <br />Applicatlo� For <br />PUBLIC WORKS PERMIT <br />P�int or Type Only <br />i <br />Puoi�cwodePermn. �-�V� �� _ <br />t�iee o�o� • 96fv4959 - <br />����,� Wo,.. �oa — <br />Totri Fee s <br />Lufn �ppi F�n Pnn1 s <br />9alance Um $ ZD_� <br />� <br />St�lrinq Homee bIW 12 707 Mukilteo �ieedwav Iiynnwood 98037 742-6544 _ <br />Owner MaiNng Atldiess Ctly Zip Fhone <br />OWISBS <br />Applicxnt <br />Describe Proposetl Work }�y�ii�r+•_. .�/J�i�X <br />Crty Lp Phone <br />., t� <br />Pro�ect Address Iil known� _�i.3pZ�(}!' -Di -- <br />Attach fow (4) copies of plaas lor pwposotl �Nerb. � Uraw to scale and nota Ihe lollowmq as apphca6le: <br />• Vroperty Lines <br />• Outline antl dimensions ol all existing and <br />proposen cmictures on the'ot <br />• Existing ^.nd ;•ro�used utilities <br />• Center�ine o� stree� pq/19/9� 1:37FM OOORH3740 <br />• Indicate North <br />• Show any p'opOsed gradippr.tiypygS <br />• Show measurements �N�'�1�'4YDY <br />PLPd'i �180.00 <br />PF.RMITCONDITIONS F, SRCH l6.50 <br />1. All cells lor inspectlon shall be matle 24 hrs. in advarice - phone 259•8810. fNN1 „n m <br />2. All work ehell be pertormed In accordance wilh tnis permil and currant Cily of Evarett Designa�ConstraL7rorc- <br />Standerds and Specificatlons. �i000i7939 <br />3. Call Locetion Untlerground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-�f(555.f30.00 <br />END I l639.20 <br />1171-5 5949.00 <br />APYT,?C�NT iHAL,*� TNFTAT,L INF7i,TRA'PTON TRENCN. (�� Ctl_ ��'?' N�AQ���1 <br />FTI�I,FD WTTH nRATN Rt��l�"� ANI� �1kF.�"T' Ai�l. nFiVRWAY nr�n RO��F"i'�E�RA7A�F103H�7'H <br />CHECI; 13376.�'0 <br />� <br />r ce.�- �11 <<r�.._ i- G- 9� <br />Approved fo�r Co�nstr `tion Dalc <br />,[�d�� i� - r- �o <br />FINAL INSPECTION <br />Approved ns Con,tructed <br />Jev� PUBLIJ WORKS DEPARTMENT <br />3200 Ceder Slreet <br />Evere�t, WA 90201 <br />Phone:259�BB10 <br />ume <br />ACHNOWLEUGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The unCe: ,iqned owneUappLcant hereby aqrees to hold and save harm� <br />less the City ol Everel� Irom any and all claims for damages, cosls. <br />e.penses, or causes ol acUon that may anse Gecnuse ul inslallation <br />and mainten2nce ol Ihe improvement or other nghl-o1 o:ay �se herelo <br />applied lor and lurther agrees to remuve same upon nutice from Ihe <br />City and lo replace pubhc property damp§ed Piereby. <br />..��` - �1 �/ — — <br />� iir�' <br />SignatJrr ol Applican�� Date <br />WORK AUTHORIZED BV THIS PEFMIT MUST BE STAPT[D WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IL° TO <br />BE DIUGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PRO,IECT OVER 90 DAYS DURATION. <br />