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Date g-6-92 � , E�3 4? Z�—�{" <br />Application For <br />PUBLIC WORKS PERMIT <br />`y' <br />Print or Type Only <br />To pnsr�Nr 9�Z0.Iq� <br />Pu01ic Worka Permlt �� 33/ / <br />eiaq. 000�. • 37..34 � <br />Publlc Worko Fae <br />Totel Fee S �- <br />Lesa Appl Fre PaiG .S ,���. <br />e,m��� o�a S 2 0°O __ <br />OCJ2 - .�z2 �a //�93 / <br />Paul LaVigne 8001 22nd Ave NW Seattle W'A 98117 782-6243 <br />Owner RAailing qddress City <br />Zip Phone <br />Owner <br />Applicant Mike LaVigne 784-1792 <br />Mailing Address �i�Y Z P <br />Phone <br />Describe Proposed Work new house <br />Pro�ect Address (if known) <br />Aqach four (4) copies of plaes for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street =�� � <br />• Outline and dimensions of all exisNng ar�r; • Indicate North <br />proposed sUuctures on the lot � • Show any proposed gratling�henpes;, <br />• Existlng and proposed utilities � <br />Show measurements ; _„ . <br />PERMIT CONDITIONS <br />1. All cells (or Inspection shell be made 2.S hrs. in advance - phone 259•8810. <br />2. Ali work shell be pertormed in accortlrince with this permit and current City of Everett Design and Conatructlon <br />Standerds and Specif:cationa <br />3. Call Locatlon Underground Service 48 hra, beforu you dig. TOLL FRE� NUMeep 1•800-4245555. <br />S <br />(O. <br />for <br />�A�/C- ClGcC'SS �!� <•e�a, </a,f� <br />or ,2'�i.�h, 30" �u! �' G'a-�,c��Z� — /5��w.de <br />A� o�e Conc�ete-�l /-:66ons <br />(�(�""ij�--4.�f Gcc�-Cc�� f2t,L G�l .i�,�o�� %ri�o � <br />•(��(!X'.cv4� J��iia-.f-c..: � , <br />�PP�.�a.,7� �o re c �i iiP �p 0 °� ')r.�,�.,, C �f'/ 7�0 :,�4 � d <br />c�riv�"'Ly �vor,�, n;'oney c_uLLetfPd q.r 4 Jyfo�y <br />4q� C✓ill .�Jc h�dled �fo „iai�lic�n-� �f�lu_7�' Cond7�.�cn <br />qpproved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 258•8810 <br />AGKNON'LEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for demepes, costs, <br />expenses, or causes of action that may arise because of Inatallation <br />and maintenance of th� improvement or other right-ohway use hereto <br />applied for and further ag�ees to remove same upon notice f�om the <br />City and to replace pu6lic property damaged thereby. <br />S' ature of Applicant c7 / ate <br />RK AUTHORIZED BY THI PER IT MUST BE STARTED WITHIN <br />0 DAYS OF DATE P°RMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />