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��� <br />C H <br />H�� <br />�C C'� <br />� <br />� H � <br />N <br />x <br />��d <br />��� <br />r�yyH <br />H <br />C9 y <br />M <br />�� <br />�O� <br />� <br />; <br />! �� <br />Date l p–S–Q2 ,� <br />Application Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�; <br />Pu�l¢ Worwf Permil • <br />BIJp.�eoi.�_3R�53 — <br />Puoiic Cbrb Fes <br />TalalFee s <br />Lesa AOU� Fea PaiC S <br />Balam e Ouo S <br />Kaneris Georqe 9031 Everqreen Wav EVerett 98204 771-5774 <br />Owner MaJing Add�ess Cily Zip Phone <br />Owner — — <br />App'icanl Mailing Address City Zip Phone <br />�escribe Proposed Work 'fp a t jmpr 1' !h' l 1 w A 1 h�,�M F W� }uY) <br />Proiecl Address (il kncwn) 96G2 Evergreen Way <br />Attach four (4) copies ot plans for preposed work - Draw to scale and note the following as applicahle: <br />• Property Lines • Centerline of streel <br />• Outline and dimensions ol all ezisting and • Indicate North <br />proposed structures on :he lot • Show any proposed �rading chanqes <br />• Ezisting and proposed utililles • Show measuremenic <br />PERMIT CONDITIONS <br />1. A�I calls for inspection shall be mada 24 hrs. in advance • phona 259�8810. <br />2. All work shall bn perlormed in eccordance with this permit and current Cily ol Everett Design and ConstruCtion <br />Standards and Specitications. <br />1. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBEH 1•800�424•5555. <br />��,6.� w�- ��` /U�` ,���Q �� ��' <br />y�B ���/92 <br />. <br />�4.,,� .Ser,,� � G�r'.� 6,e ei.�y yoa�.�^,j- �,o� <br />L�„ .�� S�o�u--��- /�..4 c.� �-/ �h�i� a. ��Ou��,a, Gdu�« <br />,�.�.� � �a.w ���-- � �a.�- .�:,,.�. <br />-�'�a,�c- c�a-.=-f Q <br />�hCc..J Lv1� • <br />y'' cua.Z�, ,a.�� � <br />ACKNOWLEDGFMENT OF CONDITIONS <br />ApFroved for Consimction Date <br />FINAL INSPECTION Date <br />Approved 2s Construc�ed <br />PUBLIC WGRKS DEPARTMENT <br />3200 Ceder Street <br />Everelt, WA 98201 <br />Phone: 259�8810 <br />W <br />H <br />� <br />N <br />� <br />O <br />The underaigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims for dameges, costs, <br />expenses, or caus��s ol xclion that may arise because of installation <br />and ntonance of the improvement or other right•ol•way use hereto <br />ap yre�1 or and further agrees to remove same pon notice Irom the <br />C t{ ar#f m reolace�ublic�property damagzd the�6y. � <br />WORK AUTHORIZED BY THIS PERMI � MUST BE START'E� WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br />BE DILIGENTLY PURSUFD TO COMPLETION. TH�S PERMIT MAY BE <br />CANCELL[D BY ThiE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 �AYS DURATION. <br />