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__� <br /> � <br /> . .,... . ----- � <br /> � �� � DatE t 1-��-0� a�cao:o�., oi »uin� � <br /> r r <br /> ta t�7 appncat�o`� "� ` <br /> , <br /> '° � x PUBLIC WORKS PERMITi °"°"""°""" <br /> ra�F�e s <br /> y1-3 f~A uu�ooifnvra S <br /> Baunce Des s <br /> K y � Print or Type Only <br /> � N � <br /> y M 258-20i5 <br /> x O � KATHY DETUREK 482d FOWLER AVF. phone <br /> t+7 Owner <br /> Ma�ing Atldress �'�Y Z�P <br /> HC <br /> Q N q_ <br /> .�.��p g N S CONSTRUCTI.ON 7202 61ST AVE SE SNOHOMISH phone <br /> n. n Mailing AEGresa �'�Y Z�p <br /> � App�icant <br /> y TI <br /> Z ri <br /> � p.� y Oescribe Propased Work ' <br /> 8y <br /> H <br /> ��y W <br /> yo� ,. � <br /> Project AdCress(il knownl � <br /> Attach four l4)copies of Plana for proposed wak• Draw to scale and note�Ceeterline ol stpeett able: � <br /> • Property 1��e5 � ��tlica�e North <br /> • Outline and dimensions of all ex�shng and � Show any proposed grading changes <br /> propo500 5tructur¢5 0��he IOt � Show meeSufem2nl5 � <br /> • Existing an0 Proposed utiiities <br /> DO NOT WFITE BELOW THIS LINE � <br /> PEFMIT CONDITIONS �� <br /> 7.All cails for inspection shall be made 24 hrs.in advance•phone 259-8810. <br /> 2.All work shall be peAormed in accordance with lhis permit and wrtent Gty o1 Everett Desipn and Construction ♦ <br /> Standards and Specitications. � <br /> 3.Call Locat�on Underground Service 4B hrs.before you dig.TOII FREE NUMBER 1•800�424'S55 . <br /> I � . ` <br /> �� /�v���� «,.�� P.�-�--�"�� ���-«, �,, .,��" Q <br /> j ��I' _�� � <br /> � Q <br /> I ' �-� . a <br /> �-- <br /> �,�� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneUapDlicant hereby agreea to hold anC save harm- <br /> less the City ol Everett Irom any and all claime lor tlamages, costs. <br /> 1� — ezpenses, or causes ot action lhat may arise because of Installalion <br /> �_ and maintenance ol the improveme�� or other right-o��way use hereto <br /> applied for and lurthe� agrees to remove 6ame upon nolice ��om lhe <br /> � � Date Giry and to replace public properry damaged thereby. <br /> - Approred lor Construction <br /> ��� Date Date <br /> FINAL INSPECTION Signature o1 Ap011cant <br /> ApO�a�ed as Constructed WORK AUTHORIZED BY THIS PERMI7 MUST BE STARTE� WITHIN <br /> PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> ��� 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BC <br /> Everett,WA9B201 CANGELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON�HI� <br /> � phone:2548810 PROJECT OVER QO DAVS DURATION. <br />