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� <br />-1.. i: <br />--- . - :�.-,..`�_ _ - _ .-.,>` -, <br />, ., �• _ ; ,., , <br />i Date 7-16-93 Tn �n��l�1r� <br />I'i '!�� Appiication For � � V <br />; PUBLIC �IVORKS PERMIT <br />I� .J t�' O p p r� O c l] p c� <br />nG�(�OI��O f1f� GSCinO�f� <br />I �' . . . . . . . <br />Pflnt Of TypO Of11y � r,i � o a� o o n ni c_ o o� o <br />i t� � .� �p v� p.J [� L� � C- v7 .r M CJ <br />ri i� N �A iw w .,� � � a+ N� M a <br />� �� � � CJ <br />� Polk Duildera Ine o:13�01 iieachenrooc{i:Dr in�Li;ll Creek $80 <br />(hme r <br />Describe Proposed Work <br />�1 <br />Mailing Address <br />C- C�����['� � [��i5 <br />� O �I � 41 J <br />]C u Li. i C J fy' <br />C�ty <br />new ho�se Lot 2 s,iur[ plat 8-93 <br />p' 1 • <br />Pu�Oc Worwa Pmmp � � <br />OL BiU90ep1• G1z97 <br />Pu�Lc W�.b Fee <br />iabl!ee S <br />pf'], � Led Appi 'ee PaiE s <br />� ` Belance Pu. i � <br />N `r:i <br />fJ <br />338-1664 <br />Proiect Address (if known� r/� �%i r.Y�L�r� �y.�dy,�_ _ <br />J <br />Attach lour (4) copies ol plans lor proposetl work � Dra�v to scale and note the following as appGcable: <br />• Property Lines • Centerline ol sireet <br />• Outline and dimensions of a�l existing �nd • Indicale Nor�h <br />proposed slructures ori the lot • Show any proposed giading changes <br />• Existing and proposed utilities • Show measurements <br />0 <br />Phone <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All worA shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underg�ound Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1-800�424•5:i55. <br />7 ) <br />/ <br />�/'" � ��Ce�e� �i �� ` <br />Approvetl for Consiruction Date ) <br />o ' <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily ol Everett from any and all cla�ms for damages. cosls, <br />expensea, or causes ol action that may arise because of installation <br />ano maintanance of the improvement or other riphl�o4way use hereto <br />applied lor and lurther agrees �o remove same upon notice trom Ihe <br />City and lo replace publlc property damaged ihereby. <br />i _ � ' _ - � � - � ,�CG � <br />I FINAL �NSPECTION Da�e � -� � _ <br />� Approved aa Constmcted Signature ol Applicanl D:ite <br />��A�� PUBLICWORKSDEPAFTIdENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR�ED WITHIN <br />I 3200CotlmStreet 180 DAYS OF DATE PERMIT IS ISSUED AND 1HEREAFTER IS TO <br />Everolt, WA9820� , BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />I Phone: 259�BB�0 � CP.NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />