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� � <br />H <br />sy� <br />H�� <br />FC c] <br />HMry� <br />� M � <br />��d <br />ON <br />��g <br />�. � <br />yH <br />rHH <br />g �' <br />C1 � V� <br />�O� <br />1 <br />1 <br />c <br />��� �^4 <br />Date 5 5 2 �_ <br />Application For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />MARK BLY 5110 D0� <br />Tn nncTlpl� <br />'sVERETT 98203 <br />� Address <br />5���,q� <br />------ <br />1977 <br />SAME <br />qpplicant Mailing Address ��'ty <br />NEW SINGLE FAMILY RESIDENCE <br />Descrihe Proposed Work <br />5020 OCEAN AVE <br />Prolect Address �il knownl <br />Puei¢ worws Pe�mn • �� � ! / <br />omo oea�.+ '�6613 <br />Puoi¢WortsFca g <br />Totnl Fea <br />Lese Aoo� ree Pa�a S�� <br />u,i���� o�< s [ <br />Attach lour (4) copies o� Plans lor proposed work � Draw lo scale . nd note �hc following as applicanle: <br />• Pmperty Lines • Centerline of street <br />• Outline and dimensions ol all eais�ing a�d • Indicate North <br />proposed slrucWres on Ihe lo� • Show any proposed grading chanqes <br />• E.Istin9 and proposed utilities • Show measurements <br />Phone <br />PERMITCONDITIONS � � <br />1. All calls lor insFection shall be made 24 hrs. in advance � phone 259•8810. . <br />2. All work shall be pedormed in accordance with this permit and currenl City of Everett Design and Constmclion <br />Stantlards and Specifications. <br />3. Call Location Underground Service 40 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�� bv'� 1 d �h �1 l�''a��� -4-+�e.nc.�; o�� PrG�ef� -�.� <br />��'°�,� �r�'l��.y,�, <br />� i���� e-�- .� � 7 <br />Appwved for Consiruction Date <br />�� �i <br />Xe�d=� S�-/u -j j <br />fINAL INSPECTION Datc <br />ppproved as Censiructed <br />�� PUBLIG WORKS DEf ARTMENT <br />,+�3200 Cedar Street <br />Everelt, WA 98201 <br />phonc 259�BB10 <br />W <br />H <br />�w <br />_ / <br />� <br />� <br />�CKNOWLED�EMENT OF CONDITIONS <br />The ��i�dersi9nr,d owner/appliean� heicUy rmrees to hold and save harm- <br />less �he Ciiy ol Everetl Irom any anJ all claims for dama9es. cosis. <br />mUenses. �r causes ol action that �wY aris,: becau:; of installation <br />and maintenance of lhe impwvemenl or other righPof-way use hereto <br />appi�ed lor and furiher a9rees to remove snme upon nolice ��om ihe <br />City a��.d W �eplace public properry damaged ihereby. <br />Si9nat ���e o� APP��_�•""�_ Da�e <br />\`JORK AUTHORIZE� OY TH ERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAT[ PER �SISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED HY THE CITY UPON AN� STOPPAGE Of WORK ON THIS <br />PROJEC70F!:R 90 DAYS DUFATION. <br />