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�Ey��y <br />0�1x <br />�Hy <br />Mi � ',i, <br />�C � <br />'� N'tl <br />NH <br />[+00� <br />OH <br />��g <br />QY (] <br />ry�H <br />g� <br />��� <br />��� <br />� <br />�' <br />-� �7 , <br />Date � 1/l0/92 1c ' �— G �.'.�^ <br />ApPlication For <br />PUBLIG WORKS PERMIT <br />Print or Type Only <br />% �J� <br />PuoLCWo�hspermn+ `� /✓ <br />em��. oeo� � 3H6fi3 <br />��r��� Wo,�s.�> <br />.a�a� F,� s <br />�ossaoo�-F��eaa�a $ /J <br />9alan<eDue S /� <br />TO POSTING _ 9 =_-qj __. <br />Leitch Jeffrey 5806-1/2 3rd Ave N[•7 Seattle, WA 98107 526-2791 <br />O�.vner �lailing AdAress City Tip Phone <br />Trigny Corp (General Contractorl <br />Applicant '.lailing Adtlress <br />Describe Proposed Work Construct new <br />ProjeCl Addre55 (il known) <br />Allach four (4) copies et plans for proposud work • Draw lo scale and nole the lollowing as appGca6le: <br />• Property Lines <br />• Outlme and dimensions of all existin9 and <br />proposed sirucWres on ihe lot <br />• Exis�ing and proposed uliliiie5 <br />• Centedine ol streel <br />• Intlicate Nort� <br />• Show any proposed grading chanqes <br />• Show mezsure�nanis <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8870. <br />2. A�I work shall be pedormed in accordance wilh ihis permil and wrrent Ciry of Everett Design end Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. tefore you dig. TOLL FPEE NUMBER 1-$00-424•5555. <br />fINALINSPEGTION'" <br />qpproved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt WA 98201 <br />Phone:259�8810 <br />ACI:NOVJLF_DGEAtENT OF CONDITIONS <br />W <br />� <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />� <br />a <br />Thc undersinned owner/aPP��cant hereby agrees fo hold and save ha�.m <br />-- I less Ihe C�ty of EvereU ��om any and all claims for dama9es, cosis. <br />Jeapenses. or causes ol n th2t may arise because ol inslalhbun <br />(/- /�'—y� and miintenance of e impro ement or other riqh4ol��vay use h�relo <br />applied for anA lurt er agrees o remove same upon notice ��om Ihe <br />Date City ay�i-to"rep�}¢Cj uUhc prop r�y damaged Ihereby. <br />Date <br />� � / <br />� Iz/��' �.Z — <br />V� <br />�c ant -J Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST OE STARTED WITHIN <br />180 D4VS �F DATE PERMIT IS ISSUED AND THEREAFTER IS Til <br />BE DiLIGEN �LY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TI1E CITY UPON ANV STOP'AGE OF WORK ON THIS <br />PROJECT OVER �JO DAYS DURATION, <br />�:.. <br />