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� <br />TYPE OR PRINT ONLY <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Eve�ett, WA 98201 259-8870 <br />TO POSTING APR� <br />� <br />oate 5/20/97 _ <br />Public Works Permit A 7C� __ <br />Building Permi� p SS l94 <br />- <br />Public Works Fee S _ _ <br />G S BALTZ3LL 12420 ROOSEVELT RD SNOHOMISH 98290 360-754-6650 <br />Owner Mailing Address City Zlp Phone <br />Applicant Mailing Addrers City Zip Phone � <br />06-05-97 2:2].Pli <br />Describe Proposed Work NE�d HOUi:E — BASIC 1226 N 55194 <br />_ �.. <br />PROJECT ADDRESS (if known) <br />BL <br />W1W{IV IL11(V <br />PLUfSIFK'i 77.00 <br />SURCHARGE 4.50 <br />Atlach four (4) copies of plans for proposed work - �raw to scale and nole the following it applicable: �J jj�jTj' �J <br />•PropeAy Lines •Outline and dimension� of all eris�ing and proposed siructures on ihe lot •Existing and proposed]�(� <br />•Centerline of sireet •InCicate North •Show any pr�posed grad�ng changes •Show measurem�iBTil� �J�.Z(i <br />UV NUI WFillt tltLVW IF11J LINt A OR 247 <br />PERMIT CONDITIONS: <br />1. All calls for inspection shatl be made 24 hours in advance - phone 259-8810. <br />2. All work shail be pertormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />G <br />1;\s �,or ruhlic �eorks �pprovcd sitc pl�n. <br />�. Inaf�ll �u� intilu�atiou irencl� built aN per Section 3-2.ti.2 a��d t�iq�vz :��d'Ihble 3-2.2 oCilie city <br />>tonuw�l� r hlsw�u�� mcut l�f�uwul (copy's ehq�led to Wi� pannit). Ti�e iufii��ation Uanch shall <br />clos,er ih;m 5 icrt to :ury up slc,pc property line cr foimdidion uor closer tlism 10 frel to :u�y do� <br />pi opert�� lin� or to�md�tion c �II 1'ublic Works tor rm incpectimi prior to coveriqe trenche�v. <br />"�'p� � <br />IyF' �''ty�i <br />-.���. 4e_]� `�� • / / <br />FINAL INSPE ION Date <br />Approved as Cons�ructed <br />`W <br />i"� <br />��A <br />V♦ <br />� <br />O <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hartnleas <br />the City of Everett fmm any and all clalms for damages, costs, expenses, or <br />causes ol action ihat may arise because of installatlon and malntenance of <br />ihe Improvement or olher right-uf-way use hereto applied for and luriher agrees <br />to remove sam�1 upon notice Irom the City and to replace public pmparty <br />damagetl thetkJJJy/ <br />WORK AUTHORIZE� BY THIS PEFMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEqEAFTER IS TO Bt OIIIGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANV STOPPAGE UF �'lORK ON THIS PROJECT OVER 9U DAYS DURATION. <br />