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Date 10/21/91 <br />Application For <br />PU�L.IC �fi/ORK� P�RNlIT <br />Print or Type Only <br />Doryann Const <br />Owner <br />Sigi Ullnoh <br />Applicanl <br />Da,cribe Proposed Work <br />Project Address (if known) <br />H-1Z-ZS'4 <br />TO POSTING ���°��z- <br />POB 2153 Everett 98203 <br />Mailing �ddress <br />290-8479 <br />Mai�iny Address <br />e <br />290=8474 <br />City <br />Zip <br />Pu�lic Works Permlt e � <br />eiae-oeo�.+ 91/279 1 _ <br />Pu�lic Works Fee <br />Total Foa $ <br />Less Aoc� Fee Pa'uf $ �'I �� <br />Balnnce Due $ �`—'� _ <br />Attach lour (4) copies of plans for pioposed werh - Draw to scale ano note the followinc� as applicable: <br />• Property Lines • Centerline ot street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed ;tructures on the lot • Show any uroposed grading cha�ges <br />• Existing and proposed utilities • Show measuremen�s <br />Phone <br />PERMIT CONDITIONS <br />t. All calls for irspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you diq. TOLL FREE NUMBER 1•800-424•5555. <br />q� Kee� �:t7 s�.re�-�S �.I ea�� a� all t',�n�e�. <br />5, ,a,n�� �✓-�-�.;n�� o� �h;s lDt is riot tu imPac�. s�,��.����� <br />proP�✓'�;e1f a��d sha�l ��o� cu-oss stee.P s�o�e �:�-G{�-. <br />�e. {��ve. c��:vc.v� -�rw� ( ro����-� 1'�h� -�o c,d9cj u�F Pave,��e.�t <br />i � ���z C� c� 6��- e�-�va . <br />� <br />����.�. ►�1 �I�. � � -z�-�� � <br />ApG��oved for Co ruclion Date <br />i <br />� ��� - 3/�9z <br />FINAL INSPECTION Date <br />Approved as ConsiructeC <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Sireet <br />Everett,WA98201 ' /5���� /a'��—�%� <br />Phone: 259�8810 .�l- �n �r� <br />/1//T <br />W <br />� <br />_ / <br />ACIWOWLEDGEMENT OF CUNDITIONS <br />-� he undersigned owner/applicanl hcreby agrees to hold and save harm- <br />less the City of Evereil from any and all claims for damages, costs, <br />ex enses, or�causes of action that may �rise because of instaliation <br />a maint n� ce of the improvement or olher righFo(-way use hereto <br />a pl d r an further agrees to remove same upon notice from the <br />Ci y n e a e public property damaged thereby. <br />, � I�� � _ <br />Signature o Applicant at <br />WORK AUTHORIZED BY THIS PERMIT MUSl� BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER ?0 DAYS DURATION. <br />