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H zo _�� -s NE. <br />Oate. 11-21-94 Tt� POSTING �a <br />�: Appllcation For <br />� PUBLIC WORKS PERMIT <br />Print or Type Only <br />IPUD1ic Worb Permlt • -�SS / ' <br />eia9.oeo�.• 46272 6 7� <br />PuEI¢ WOA� Fee <br />Tot�l Fee s <br />Less Aoa� Fee P�iE � <br />6�hnca Oue i z 0�o <br />(io2 32Zyo//83/ <br />Larry Nalbach 2132 Highland Ave Everett WA 98201 252-7450 <br />Owner MelNng Address City Zip Phone <br />Owner <br />Applicant Meiling Address City 2ip Phone <br />Deacribe aroposed work Znd atory addn to SFR for Duplex, new townhouse duplex <br />Prolect Atldress (if known) <br />Attach four (4) copies of plans fo� proposed work - Draw to scale and note the following as applicable: �� �112.1� <br />• Property Lines • Canterline of street �� f120.� <br />• Outline and dimenaions of all existing and • Indicale North <br />proposed structures on the lot • Show any proposed gradi�ges ��� <br />• Existing and proposed utilities • Show measurements lU1i�1 �.� <br />PERMITCONDITIONS �� f��•� <br />t. All cella for Inspectlon ehell be mede 24 hra In advance • phone 259�8810. �� <br />2. All work ehell be peAamed In exordanca with thie permit and current City of Everett Deal��Cona�i�00 <br />Standardn and SpeCificatlons �,29967 <br />3. Call Locetlon Underyround Service 48 hra before you dip. TOLL FREE NUMlER 1-800�555.j�p�� <br />SVSOEV f141T.00 <br />� Lf/OI�� ro .�L" o�dne�r� QPPro✓c�o��OLrtns BL��l419.OD <br />' df�d �-�-�' -9s�. �o�f' Qt/,������ w.ec se+.00 <br />nECH si2o.00 <br />sac�c s�.so <br />PLH CN t272.35 <br />CEIECK f50�.05 <br />', ,�>� /a/�/� �- <br />Approved for o ucti Date <br />.4— � � '7 <br />PINAL INSPECTION Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cadar Street <br />Everett, WA 98201 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CC�NDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/epplicant hereby agrc�es to hold and save harm- <br />less the City of EvereU trom any end all cl��ims lor damagea, costs, <br />expenses, or ceuses of action that may aris�s because of inatallation <br />and maintenance of lhe improvemant or other righl•of-way use hereto <br />applied for and further agrees to remove aeme upon notice irom the <br />City and to replace public property damaged tnereby. <br />� s l� <br />Signature of App ica t Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURFTION. <br />