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Application For <br />4�w PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />TO POSTING Ej�S@)t,yVFI9&^L1+(425)257-8810 <br />TYPE OR PRINT ONLY UUflfl U 1 LUO <br />SHARMA BRIJ 6018 187TH PL SW <br />Owner Mailing Address <br />Applicant <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />NEW HOUSE <br />Date 4/9/99 / <br />Public Works Permit If 91513 11 <br />Building Permit M 60385 <br />Public Works Fee $ 26 <br />LYNNWOOD 98037 425-776-7562 <br />City Zip Phone <br />vu - <br />Phone <br />Attach lour (4) copies plans for proposed work - Draw to scale and note the following if applicable. <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities <br />• Centerline of street • Indicate North • Show any proposed grading changes • Show measurements <br />z <br />O <br />.i • PII�� <br />,1rIVmili 5hAfl n1A � U &,Ama b1C(/?lbaor7 Zr5 L%t2 ek;54,,nJ c4tof <br />pq,m 1✓ tAm i-E mec+S fiol6aA7kAve -(of A d AAvic-0, &-r" 51 Nrb� O <br />(JT Y� NOri�i� ed� 07 QLf11eh1P.✓>t Qh i'}OI�MaO(C/4VC I�OhG -[Jce �✓A�G Iti <br />�,✓I -� -bAz 9Avwll f IS �jt✓TiY'LPJ �v i CMG 1rpon I Oo LiP�l <br />GieS+X'1?,V1 , ww'%-�i. I <br />5- rbv,de A� IM fkrif�;oO LrevTc�, Och;9ned and Ijv; Ft e %rPTttirtisrr S <br />*f3-2.&.z tz�k 3-2,z z•,d 3-2.7- all5iTpteJ-Ev ",<pe t L-. <br />r%. �jewrr� > rorr, b�i5 Lv� w 11 r-�d; re z F'"'1 5�r>le,+, �r d sc�rx� { v 4t. me:`fh <br />/i .l k br-w ic Ave. - 'K4 ('r-i vALe �#MP S s <br />s-A4a h 5 lI d rsch�r z P vie is Mcr�11 bk <br />L A- .ik edgj2o-f -�Az g-0w. �bm w�7Gbr A qov; Sine *�("O l <br />pe-K _4J*?2444§O NOT WRITE BELOW THIS LINE <br />d� PERMIT CONDITIONS: 1269KeviCf &NCCCJIMq 41,ntjte RONitHd 8•on friV2116C fFM�F. ShAfl bo <br />1. All calls for inspection shall be made 24 hour in advance - phone (425) 257-8810 fll5iynedrrd St7wyeJ <br />2. All work shall be performed in accordance with Viis permit and current City of Everett Design and tKj P1 <br />Construction Standards and Specifications.. 0&-rAI )ci+9iltlN, <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />w01 Otilc' XlC4>< MR� of rOV;' fIt joq,kf <br />ACKNNOWLEDGEMENT OF C NDITIONS 'Ott fill <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses. or <br />causes of action that may arise because of installation and maintenance of the <br />improvement or other right-of-way use hereto applied for and further agrees to <br />remove same upon notice from the City and to replace public property dam- <br />aged there <br />5icptam�,p{�rR.erir ate — <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />