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. C <br /> � Application For � <br /> ���� PUBLIC WORKS PERMIT Date 3-5-96 -�� ; <br /> PUBUC W�7FiKS DEPARTN!ENT Public Works Partntt M ��/� 1 � I <br /> �0 POSTING 3z°°_�`5,�, � <br /> e�emn,wqie2oi 259-8910 <br /> ; � Building PermR M 5 1034 I <br /> I TYPE OF PRINT ONLY T ' '`-; 7_r� �� ��' �ti � o i � 'r,�� �i � �T; � �ti ,s'j�j�._ li <br /> i ' �� . � M c, in r,: ci ... � PuE�J�r�s,EMS�. '�b' : <br /> �' ' .y;� -�;� " r t r'. � � �l': +� f1 �� �� tJ <br /> Il1 A �11 «e I: w� �4 M' .^1 «. M ff ', <br /> O I <br /> � Theo Construction i'0 Ln;: :(�k"i5 Bothell`-�Fj�yl-2U65 �'106-486-,%643' '" <br /> � Owner Mallirp/bdrasi� ="+ rp�� '�- .�rty 2IP u _ x Phone �, <br /> ,�� 3f� f� 22S �i � S: � �^ :� r .K ' �. ? rj I <br /> L] tJ U � i � tJi i � � pJ �i� ' 4i <br /> (hmer Terl nx lliana Se1�Tt `�'� �i n � i� n a � ,' �:� � '`� �� - � � ;�� '}, �'s � .'; <br /> Apphcant Mailing Addresk" City Zip Phone <br /> I <br /> Describe Proposed Work new howe ' <br /> I � I� <br /> � <br /> � � <br /> � <br /> PROJECTADDRESS(ifknown) 11011 Fainc Fi_eld 41a�• .� ;,ot 4 SP ;174-9G � <br /> � Attach four(4)wpies o1 plans for pnoposed work-Draw to acale and note the following N applicable: � � <br /> � � <br /> •Property Lines 'Outlina and Aimenelons of all existing and proposeE structures on the lot •Existing and proposed utiltties �� <br /> 'Centarline of streat •Indicate North 5how any proposed grading changes •Show measuraments � � <br /> DO NC�T WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: � I� <br /> � 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. <br /> i 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and O � <br /> � Construction Standards and Specifications. � <br /> I 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � � <br /> I <br /> 1 ItnoNo�• drainaGc shall bc di�chugcd: �/ � <br /> . i�n �!,e site'e �tonn c1r�n syxtem (privxt�+ or public} O I <br /> . '1'u :� rrKiilru�ial ruofJownKpout ��.Irtn slr�ir��e�l ��ri ,�+cti;�n I-9 .1 01 Un• A i <br /> c�l� :;I,mdards Ii <br /> . ��mo cpla�h blocks I <br /> Ttie meUiod Aelecfed will h�� sut�iect to Public Worl;e llep:ulement approval. ' <br /> i <br /> � <br /> ' I <br /> I <br /> I <br /> �� -;;` /�� I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> i �� /� �1 � / � The undersigned ownedapplicant hereby agrees to hold and save hartnleas �i <br /> �G�iC•[/C.�� �/ �C.¢..�. �/���y/,-., the City ot Everett from any and all claims for damages.wsts,ezpenses,or <br /> � � causes oi action thet may arise because ot installation and maintenance of I <br /> IAppro/edfialConstrvction _ Date theimprovementorotherngM-of-wayuseheretoappliedforandfurtheragrees 'i <br /> %�� �"—' ��,%� /� � to remove aame upon notice from the City and to replace public property i <br /> ��.��',r�� _��� ���`��i-; / � � '/�!;��� �amagedtheteby. � <br /> FlNALINSPECTI � « Date ii ,' ;� �� <br /> Approved as Constructed � ` % ' <br /> I -��.:T�����_���.�T�����r �x 3=zs�� <br /> i \ SI$nature of Applicant Date I <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DAT'E1fERMR IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO � <br /> I CAMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS FROJECT OVER 90 DAYS DURATION. '' <br />