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DBtC 11 27 91 � � Pu�llc Works Permll• <br /> � Bma.oro�-• 91/28211 <br /> qpplication For <br /> PUBLIC WORKS PERMIT P°°'"`"°'"'°°° s <br /> Total Fao <br /> Lass Aoo�Fea PeiE .S <br /> iee�ance Oue S <br /> � Print or Type Only <br /> Jce Kuchinski 190I1 Delvrood Dr Edmonds WA phone <br /> Owner <br /> Mailing Address Ci�y 2ip . <br /> nwood, WA 98037 743-1555 _ <br /> Permabilt 16521 Hiway 99 LYn Phone '��� <br /> ' Mailing Address ���Y Z�P <br /> ' APPlicant ;].�`, <br /> � , <br /> i <br /> � Describe Proposed Work <br /> �' W <br /> � Prolecl Address(if knownl 113 Mc ill � <br /> �� <br /> � Attach four(4)copies ol p�ans for proposed work• Draw to scale and note the lollowing as appGcabie: � <br /> • property Lines • Centerline of street <br /> � • Indicate North <br /> � � Outline and dimensions of ell existi�g and � Show any proposed grading changes <br /> � proposed structures on the lot � Show measurements M <br /> • Existing and proposad utiiities W <br /> DO NOT WRITE BELOW THIS LINE O <br /> i pERMIT CONDITIONS � <br /> � 1.A�1 calls for inspection shall be mede 24 hrs.i�advence-phone 259-8810. <br /> � 2,All work shall be performed in eccordance with this permit and wrrent City of Everett Design and Conslruct{on <br /> � StenderdsandSpecificetlons � <br /> 3.Cell Locet�on Underground Service 48 hrs.before You dig.TOLL FREE NUMBER 1•800-424•5555. <br /> /%�U�� Cv�� �—��"`�l`/�°�`' '��r`�"".� Q <br /> s � <br /> �� <br /> �z-z�/ N <br /> O <br /> a <br /> ACKNOWI-EDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save harm� <br /> less ihe City of Everelt irom any and all cla�ms tor damages, costs, <br /> expenses, or causes of action that may erise because of installation <br /> and maintenance ol the improvement or other right�of�way use hereto <br /> applied for and fur�her agrees to rr nove same upun notice Irom Ihe <br /> Appmved for Construction <br /> Date City and to replace public properly � �maged thereby. <br /> Da�e Date <br /> FINAL INSPECTION Signature of Applicant <br /> Approved as Constructed WORK AUTHORIZED BY THIS P: ,AIT MUST BE STARTED WITHIN <br /> � PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS iSSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> cverett,WA 9B201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•0810 PROJECT OVER 90 DAYS DURATION. J <br />