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Date +���a_og I''�r7 G��� <br />� Application FOr <br />'' PUBLIC WORKS PERIlAIT <br />PriMorTypeOn�O POSTING �'S�� <br />% <br />o�o��wo...o.,m,. �f 3 SCr <br />e�ao oeo�. • 39662 <br />vw� _ wo�.� see <br />muisee 5 <br />teu eooi r�e P��o 5 _ <br />o.m .o�s 57D� <br />Aldervood Cus[om Nomes 3106 79ch Ave NC Everett WA 98205 334-2789 <br />Owner Mailin9 Atltlress C�ty Zip Phone <br />Owner <br />Applicant Maillny AtltlrCs'+ Ci�y Zip Phone <br />new hour;e <br />Describe PwposCJ Work _— <br />Prolect AtlOress (il k�iownl <br />4��ach low (4� copies o� p�2n5 10� pmposed woek - Draw �o scale antl nob Ibe lollowing a. ap01ica01¢: <br />s Piaperty Lines • Centedina ot streM <br />• Outline antl tlimensions of all exishng an0 • Intl'�cate North <br />proposetl struCtures on Ihe lol • Show any p�oposetl �ratling changos <br />• Existing anE pmposed utilities • Show mcasurements <br />PEFiMIT CONUITIONS <br />1. All calls /or inspeclion shall Ee matle 24 hrs. in etivance - phone 259•8810. <br />2. All work shall ba peAarmetl in accortlance wil� this permit antl current City of Everett DesiB� antl Lonstructioc <br />Slantlartls antl Specilications <br />3. Call Localion Undergroun0 Service 48 hrs. belore you tlig. TOLL FREE NUM9Efl 1•800-424-5555. <br />�`\ <br />�,.L{yf �,(�_c.e, ,3 —4— r 3 <br />APpwv �tl lor Const�tion Dale <br />,�� 7� j-L��Y3 <br />FlNAL INSPEC7'ION Dale <br />Approvc0 as ConsVuctetl <br />PUBLIC WOFKS DEPARiMENT <br />_i�'� dr.CGCetlarErtwt <br />� �`�' Lverell. WA 48201 <br />Fnnav.25FBB10 <br />ACKNOWL[DGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />0 <br />� <br />T�e undersignetl owner/apPliwnl hereby agrees to M1oltl antl save narm� <br />less Ihe Gty of Everetl Irom any antl all claims for damages, r,osi,. <br />ezpenses, or causes o7 action thal may arise becawe ol instaltaiion <br />anE mainienance 0� Ihe impwvement or Oiher iigp4o4way use herelo <br />aVPliea o antl furNer agrces to remove samo upon nolice Iwm Ihe <br />C'�ly an t rep�aca public properry JamageC thereby. <br />�� ���j.� ---�{Jo� 3��3�`13 <br />SignaWr�ulApplican� t T Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE ST4RTED WITHIN <br />1B0 OAVS OF DATE PERMIT IS ISSl1ED ANO THE,fcAPTER IS TO <br />BE DILIGENTLV PUflSUED TO COMPLETION. iHIS PERMIT MAV BE <br />CANCELLED BV THE CITV UPON ANV STOPPAGE C° WORK ON TMIS <br />P�OJECT OVEii 90 D�VS OURATION <br />