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��.�. �: � <br />, -- - <br /> u <br /> it <br /> 5/23/94 S= q���7 <br /> Date '` �,��,��.�m,�:P,.,�,�,. _/ <br /> Application For ��, oi��n oeoi . <br /> � <br /> PUl3Ll�� WORKS PERMIT � v1TolalFppF"c S <br /> � less auui Fe��P:nn S <br /> O <br /> � ��� <br /> Print ar Type Only j ' � � o a e,�.,���.o��., s y� -- ' <br /> � � � � voZ -.�z25�oi�9.3'.�/ �,L(� <br /> � <br /> � <br /> Athena Doolittle 10312 Hiway 99 S Everet�k, � (206) 353-4844 <br /> Owner f�1���irc; 4ddress U����� <br /> ) V o� [c s.7_iP Phonc <br /> � o = w <br /> � o �- x <br /> p. �LOrI <br /> �ame o <br /> � APPlicant C^:,��lin::�ddr��,s .—____—�it� Zlp Phone —�— <br /> Describe Proposed Work 80 yards,_fill�_gradin�a_v_acan_t_1ot____ ___ <br />� _ ----- <br /> ------------'------------- W <br /> Project Address�it known; _LQ312-.Elcergreen_-Way___ _____— � <br /> Attach four(4) copies of plans fci Uropose� wo�ti- Drav: t:� -c.ii�: .in:f ncte rha loilo�.ving as anpliwbia: � � <br /> • Pronerty Lines • Centerline nl sireNt � j <br /> • Outhne and dimensions ol all ex,shng ond • IndicaL North � <br /> I proposed structures on tne Io[ • Shrnv any r.roposed gradinp r.hang�•s I <br /> • Existing and proposed utilities • Show measurements � I <br /> � DO NOT WRITE �[LOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calis 1or inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Servicr.48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> 4. The wetland area should be cleaned of all debris, i.e. , old tires, discarded A <br /> lumber, concrete blocks, and litter. � <br /> � <br /> V/ <br /> O <br /> � <br /> ACKNOWLEDCiGMENT OF CONDITIONS <br /> Th���inder�iqned owner/appimant nereby agrees to hold and s2ve harm� <br /> —� � less ;he Cdy ot Everett Irom any and all claims for damages. costs. <br /> � ; expenses. or causes of action that may arls= Uer.ause of insiallation <br /> � �C //��id maintenanr.e o! tn� improvement or other right�ol-way use hereto <br /> j,� 3ppi�n,; for and further agiees to remove samn upon notice from the <br /> Ap roved Constru � n D� i C;ty. .��;rt to replaca public properry damaged thereby. <br /> �orc r/o.-.�' T`� �e �o-�«�� j �/-j,/--/�//J �,,gJ�/� ' - <br /> FINAL INSPECTION � Date �� ! ' '���' �N�"�� _� <br /> Approved as Constructed i Signaiwe o�Applican± rn Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTIiORIZED BY TliIS PERIv11T MUST BE STARTED WITHIN <br /> �200CedarSiree� i 1H0 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Gverett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Phone:259-8870 , CANCEL!.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I PRO-iECT OVER 90 DAVS DURATION. <br />