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a� � L- S-�a-S � � � <br /> �ymm CI� ('uLLC WOrk>Pa�mi\� ��-- <br /> y y � Date 9-4-91 91/27G 2 <br /> x eine oeo�.�__—�--_ <br /> Application For <br /> �y� PERMIT P�o�,�Wo,k,�ae S <br /> PU'BLIC WORKS TalelFee <br /> �'�tl y H ,..�. <br /> Les�Aoo�Fae�e�a � <br /> � �� � , ., �, �„ � �, � ��; <br /> TO POSTING__�� L �r�a���o�� � � <br /> C <br /> Print or Type Only <br /> O H ��i t– o c�m �.,�, ^ :-; �_' 1.�� irv <br /> � �g �:: ;� „.- �; :,; � . .� � � „; �r <br /> � <br /> Q` n r� �-� c/o 4415 Tom Marks�Rd Snohomish 98290 335-0413 _ <br /> �..� peggy Ne150T r� J ���Y Z�p Phone <br /> �y� Owncr ^� � P r^ 1 ;T,Me'�in¢�ddres3 <br /> c pi . u <br /> N H `. :_� `'� .� „� >' ` �. ;'� Cz o r i�i <br /> C V� Daryl Thomas o -�. ._ . same-� c� ..:. m :r; � %., <br /> n Cy y qpplicant Mailinq Address <br /> City Zip Phone <br /> �� f/i Describe Proposed Work <br /> HOcn _ — <br /> W <br /> Proiect Address�if known� 5807 Btoadwa � . <br /> �� <br /> AUach tour 14)copies ol plans br proposed work- Draw to scale and note the lollowing as applicable: � , <br /> • properry Lines • Centerline ol sireel <br /> • Indicale North <br /> • Outline and dimensions of ail ezisting and � Show any p�oposed grading changes <br /> proposedsVucWresonihelot � ghow measurements M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE BELOW THIS UNE O <br /> i �. PEfiM1T CONDITIONS � <br /> C'�, 1,All calls for inspeciion shall be mede 24 hrs.in advance-Phone 259•8810. <br /> i Z All work shall be pertormed in accordance with this permit and current City of[verett Design and Constmction <br /> ! Slandards and Spec'�fications. � <br /> � 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•42�1-5555. <br /> 1 1��� .�,TIG�TL�tiIE ST�2M I�PAtuQUE'TO s-re2M ve�.�N�E sTUB- � <br /> Uv i (�20�l�O'c� �T NE G02NE2. OP �-o�. <br /> i r♦^ <br /> I �� 5 v�I <br /> � I��sj a <br /> ���� . <br /> A <br /> 1 !'�' /��I1X1I� ACKNOWLEDGEMENT OF CONDITIONS <br /> � � �'��,1(/– The undersigned owner/appliwn�herehY agrees to hold and save harm- <br /> ,I less Ihe Cily ot Everelt irom any and all claims lor damages, costs, <br /> expenses, or causes of action Ihal may arise because o1 installa�ion <br /> �'�� � c� and maintenance oi lhe improvement or other righPol-way use herero <br /> L�. n A,.��-�QQ �Q– 7–� � applieA lor and lurthcr agrees to iemove same upon notice Irom the <br /> Appruved br Construction - Date Cily�nd t eplace public property damaged ihereby. <br /> �� � � <br /> � 3—i� ���— I C�,u,4 ���� w�— i �—q'� <br /> il�lGif.� `. � <br /> `� Date <br /> FINAL INSPECTION Date <br /> Signal e of App� an4! <br /> Approved as Constructed �/,�ORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> �–J PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUeD AND THEREAFTER IS TO <br /> IOj--', 3200CedarStreet BE DILIGENTIY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> A°" Everelt,WA 98201 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />