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� � <br />H <br />; y <br />K�n <br />H 7C <br />'� �-xl "�� <br />�q H <br />'Y <br />�HC <br />OM <br />H�g <br />(�]Y (% <br />t"y� <br />�yH <br />�y N <br />L�1 y <br />�O� <br />Date 1� Td 1 � J I � li �—r' �'"{-q? <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />/� i <br />Publlc Works Pc�mil � � � ` •" � <br />oiao oeo�. • �2/35�54 <br />Puol¢ wo�ks Foe $ <br />Toial Fco <br />lese RPpI Fee Pa��d 5 <br />GU�rO <br />eaiancc ouo S — <br />Lawrei�ce & Jeanne Nalbach 2132 High��*+d Av xt� rr- ae o� 252-7950 <br />Owner Mailing Atltlress City Zip P�ione <br />Owner <br />Applicant Mailin� Address City Zip Phone <br />Describe Proposed Work New triplex <br />Project Address (il kno�vn? <br />A�tach lour (4) copies ol plans for proposed work • Draw to scale and nole the lollowing as applicable: <br />• Property Lines • Centedine of street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposetl grading changes <br />• Existing and proposed utilitic:s • Show measurements <br />LI <br />PERMIT CONDITIONS <br />1. All calls for Inspeclion shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with ihis permil and current Cily of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBEN 1•800�$24-$555. <br />� .X-�a'� Lt 4":� �� ,l� �j� i � r�, �2. <br />� `'j';> -?.�f��� j > <br />�]f'�G,s .��• ::-t ..� � .'�� �'�-%:' <br />' I�; 1`it � I l 1� 1 L� ��� <br />II `J L L � <br />Jn ' <br />�.�M1� � n ;C�iJ2 <br />.......... . .. .. <br />crrv a: E_,�._,;�:r: <br />8�.;!._... C:�:ic..,.. <br />��'/.-��. �-�� -�//�� <br />Apprave�i lor Consjruction , � • Date <br />L /� <br />,r�..:fBL(.�— �-/t-l3 <br />FINAL INSPECTION Oatc <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett. WA 98201 <br />Phone:259�8810 <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />N <br />� <br />O <br />� <br />� <br />O <br />rw <br />_I <br />Q <br />a <br />7he undersigned owner/apPlicant hercby ayrees to hold and save harm� <br />less ihe Ci�y ot Everelt Irom nny and all claims lor Aamages, cosis, <br />ezpenses, or ca�ses of action ihat may arise because of installation <br />and maintenance ol :he improvemenl or other righl-ol�way use hereto <br />applied lor and furiher agrees lo remove same upon notice Irom ihe <br />City and to replace pubGc properry damaged ihereby. <br />Sign. Wre ol APPIic�� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAY� OF DATE PERMIT ;S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLE��ION. THIS PERMIT MAY BE <br />CANCELLED BY TI1E CITY UPON AN V STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />