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rl�a <br />� � <br />H <br />ayw <br />y�H <br />K C� <br />H :U <br />� H '� <br />VJ N <br />[�1 O � <br />�3 <br />Q H <br />�/1 �, 8 <br />y� V C] <br />z>y� <br />rNH <br />g �' <br />C] C7 C� <br />��Crrl <br />x y �n <br />H O Vr <br />Dale�`L4l91 :�y <br />Applicati.,.. Fa� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />rv, PuO��[ItiortiMrmil� <br />eiay oco�� • �7✓��637 <br />Puaiic wo�ks Fee S <br />Total Fa� <br />LnSSPppI FeOGad `S <br />pa�encn Dur S _ <br />Robert B. Norling Sr. 3311 Grand Ave Everett 98201 25"L-9878 <br />Owner lda�ling Address C�ty Zip Phone <br />Owner <br />Mailin� <br />Describe Proposed Work Con trLet nrw �atag� "^":^;^^ •.•'11 <br />Prolect Address (il known) 3311 GZ'and AVe. <br />Zin Phone <br />Attach four (4) cop�es ol plans lor proposed work - Draw to scale and note ihe following as applicable: <br />• Properry Lines • Centedine ol street <br />• Oulline and dimensions ol ell existing and • Indicate North <br />proposetl s�ructures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone Q59•8810. <br />2. All work shall be pertormed in accordance wilh this permit and current Cily ol Evere�t Design and Construction <br />Standards and Specifications. <br />3. Call Location Untlerg�ound Service 48 hrs. belore you dig. TOLL FREE NUMBEH 1-800-424•5555. <br />/�/y(:'c[�. �(-'<'Z/i�J�'.: �.�: f- /L��r�' .�'�,4e. i..(; <br />/) � � [ /�Llnief _.ILTL- q.LZ`li.�� �'4t, .Si�C —.S•'«.•�.t-- <br />F! //.A.[ l4tY �%�LG,rtOO�l; ` /"' 0 /, . <br />( E./•/C.D 'J�u[�%f��(:cc.n.IXn COi7C.'C. �CGs2h:,_ ;`�`L J'O.Y^Jcf/, <br />�. ,� �.� � � <br />,«<��.�:� . � <br />lor Construction <br />Date <br />FINAL INSPECTION Date <br />ApproveA a= ^�nstr�cted <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Sireet <br />� Everett.WA�JB20t <br />Phonc 259-8210 <br />.,�� <br />;-„_y, <br />� �z_� -� � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />-w <br />�/ <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant hereby a9�ees lo hold and save harm� <br />less Ihe Cdy of Everett from any and all claims lor damages, cosis. <br />expenses, or causes ol a on that m�y arise because ol installation <br />and maintenance ol ihe ir ,- mment or olher rlghCol�way use hereto <br />applied lor and lurther a�rees to remove same upon notice Iwm the <br />City and to replace public properry damaged Ihereby. <br />0 <br />,��) �: �. � '� <br />Si natwe ot Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITI�IIN <br />IBO DAVS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C�NCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />P <br />