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0 <br /> �- <br /> �� <br /> �� <br /> 4 <br /> Date �1/1�/o� Pu�lic Woeks Parmit d � �" <br /> Applicatlon For BIdB DeO� + 83 1 G92 <br /> PUBLIC WORKS PERMIT Pu�TotalFeyFee 5 ,��- <br /> Less ApO�Feo Faitl S��J - <br /> 0aiance D�e 5 /�v <br /> Print or Type Only � 7� �v <br /> DUJARDIN DEVCLOPb1ENT PO IIOX 5308 Everett lUA 98206 334-5018 <br /> Gwner Mailing Address Ciry Zip Phone <br /> pplicant Mailing Address City Zip Phone <br /> DescribeProposedWork einglP famil� r�cid�nre <br /> — as � <br /> Prolect Address(if knoven) i n t 7 _,],'u T n t r ' t � � <br /> � <br /> Attach tour(4) copies of plans for proposed work- Draw to scale and note ihe tollowing as applicable: � <br /> • Property Lines • Centerline of sireet ♦^ <br /> • Outline and dimensions of all existin�and • Indicate North V� <br /> proposed struclures on lhe loi • Show any proposad grading changes <br /> • Existing and propos?d utilities • Show measurem�nts qp� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspeclion shall be madP 24 hrs. in arlvance- phone 259•8815. � <br /> 2. A{I work shall be performed in acr,rdance wi�h ihis permit and currenl City ot Everelt Design and Consiruction <br /> Standards and Specificalions. <br /> 3. Call Location Underc�round Service 48 hrs. before you diri.TOLL FREE NUMBER 1•800•424-5555. � <br /> 4. Per approved plans signed 12/7/83 and preliminsry plat approval 6-79. � <br /> I <br /> Y/ <br /> OA <br /> Idr <br /> ACKNOWLECGEMENT OF CONDITIONS <br /> The undersigned owner/apph;ant hereby agrees to hold and save harm- <br /> less ihe Gi�y of Everetl from .�y and all claims for damages, costs, <br /> ��. , / expenses, or causes of action lhut may arise because of installa�ion <br /> � and maintenance of lhe improvernent or other righ4of-way use hereto <br /> applied for and fur�her agrees tu remove same upon notice trom ihe <br /> Approved lor Constr ' n � �e City and to replace public properry damaoed �hereby. <br /> FINAL I�SP/ TION �a1e � ' _�G `n <br /> s Apprcved a:Conslructed Si</� �I APPlicant Dal <br /> WORK UTHORIZED Y THIS PERMIT PAUST BE START�D WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 7gp pAYS OF DATE PERMIT IS ISSUED ANG THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PUfiSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS CIURATION. <br /> � .�t <br />