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Date ( � wex�won.r.,mn• <br /> eua o.n• <br /> ppplicetlon For <br /> PUBLIC WORKS PERMIT weucwonurti <br /> TqYFw / <br /> � t�u�ppl Fn Ma/ <br /> B��nc�Gw � <br /> Print or Type Only <br /> Plan Ch�Ck Nas B 37183 S6PA <br /> Applicai.Dat�s 06/29 92 <br /> Job Addt���� 16b5 RIDA DR Z�p Phone <br /> Owner pwn�c� N1�RTL6Y� 8T6V6 , <br /> T�n�nt� <br /> Prapo�sd U��s STOW�CB <br /> Da�c. of Nork: <br /> ADOlicant Dg� �� p���NT OF TMILBR Z�p Phone <br /> OFpIC6 SET JOB SST <br /> Describe PropaseE N <br /> APPAOVED POR PBRMST� D71TE_/_�_ BY <br /> W <br /> Pro�ect Atldrese pt known) H <br /> Attac�lour�4)CODies ol plane for proposed wolk•Draw�o scale and note t�e lollowlnp aa appllCeble: � <br /> •Property Linea •Centerline of slree� /A <br /> •Outline end tlimenniona oi all exieting antl •Indicate Norih V� <br /> proposetl nlructuree on t�e lot •Show eny proOaaeA Orading Chengea <br /> •Exlsling an0 proponeO utllitles •Show meaeuremenle � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.AII calls for inapeclion ehall ba meda 24 hre.In advance•phone 259�8810. � <br /> 2.All vrork ehell be peAormed�n accorCance wlth thie permlt anC cunenl City ol Evarelt�esipn end Constructlon <br /> Stenderdn and Specilkationa <br /> 3.Cell Locallon Underpround Sarvice 48 hn before you Ci4 TOLL FREE NUMBER�•800�424-55$5. � <br /> ���/�.��. c:.�<�.G';��.,,.,..{� ii/r 4� " i, � <br /> ���u,�- rA <br /> � , V+ <br /> 7 ! / 2 O <br /> a <br /> ACKNOWLEDGEMENT OF CON�ITIONS <br /> The undersiBnatl owner/eDGlicanl heraby eprees to holtl and save herm• <br /> less the City of Everett irom eny and all clalms fo�damages, coats, <br /> expensea, or ceusea of eclion I�et may a�lee becauae ot Inalallatlon <br /> and meinlenence oi tlle improvement or ot�er rIgllFol�way uae hereto <br /> epplleO lor end�uflher agfeea to femove aeme upon notice Irom t�e <br /> APO�oretl lor Constmction �B1e City and to repiace public properly damaped t�ereby. <br /> FINAL INSPECTION Dale <br /> pVomvetl as Connimctetl SiO�eture ol ApO��cant Date <br /> � PUBUC WORKS DEPARTMENT �'+'.�RK AUTHOPIZE� BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Ce0erSireel 780 DFVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA9B201 BE DILIGENTL�PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phona:2E9�8810 CANCELLED BV THE CI7Y UPON ANY STOPPAGE OF WOflK ON TMIS <br /> PROJECT OVER 90 DAVS DURATION. <br />