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Hn� <br /> �7 <br /> o x <br /> c f-� <br /> 9 H U� <br /> Y <br /> H � <br /> �H � � <br /> �H I� PUC��c Worha Parm�• (� l�� <br /> y y� Date_3.-�+�2 Tp POSTIt,G LL L eiae oeoi • 92�353_— 34-- <br /> � � Application For � -�---- <br /> � d Wl?RK� PERMIT vuoi�cWor.efen S— <br /> �y�� �y pUBLIC '°„'�°' <br /> H [�+1 O � ics,eooi.r�e v.�e 5 <br /> pu O ', :. � oaia�ccD�r S � <br /> y y � Print or Type Only , �1; <br /> t� L <br /> H H ,J � • <br /> pN f;; <br /> O F"� _�_4 Phone <br /> q C(A l;a hron� 1:i�— .. F Y . .. ip <br /> �� t. Owner h13�Vinq Address __; !� � , It ' . <br /> i,i <br /> C�7 - � i i ' �..� � � �r -°' �� r�-�. <br /> y y � Phone <br /> �3 O N --�'—' r,l.siling AJdress C�tY Zip � <br /> ApPlicant r <br /> LOT 31 <br /> Dc�cribe ProPose.o Wo:�k .�c�..::7�E— _ <br /> — _—_ � <br /> -� � _ ���Z1 L71/��V ��/L � <br /> Proiecl Address(if known) �� <br /> Attach lour(4)copies o�plans for proposed work• D�aw to scale and note�Ceote��ne of tpeet able: � <br /> • Properry Lines • Indicate Norih <br /> • Oulline and dlmension5 0l all ezisting and � $how any proposed grad�ng change.s � _ <br /> p�oposed struclures on lhe bt � ghow measuremenis <br /> '�1 • Exislinq and proposed ulililies <br /> ' DO NOi WI+TE 8[LOW TNIS LINE O <br /> 1 � <br /> PERMIT CONDITIONS <br /> '�1 7.All calls lor incDection shall be made 24 hrs.in advanco-Phone 259•8810. <br /> 2.All work shnll 6e redormed in accordance with this permit and current Giry ot Everett Design and Consiruction � <br /> Standards and SPecifications. <br /> '�� 3.Call Locaticn Underground Service 48 hrs.belore you dig.TOLL F9EE NUMBER 1•B00•424•555 . <br /> 1 4 9t,an;lar�lrfs`?Of3r:+n�rernsinn rnntrolPasAdirer.aedVby�Publir�W�rkev O <br /> ' lnspectnr. � <br /> �j. KP_Pp ritv strPets �le?n at a11 timea <br /> � ' 6 anvhda nagerthPretodsha] ] be rePlaced atetheWdi arret�ion�ofdt,hF ♦A <br /> ♦/♦ <br /> �,�� Publi.r. Worke Inspector. O <br /> '?. Anv chan�e in the dri.vewaY cut muet be approved hv thP Pul�lir <br /> '�' Works Inapector. ^ <br /> 8. Ti�htline al] roof, yard and drivewaY draine Y,o gtorm drain `i <br /> E,.� sY.ube at Uar_k Fide of sidewalk. <br /> �,� 9. Ad.iuEt wat:er h�xeF t� erade at end of construct.ion. <br /> � ;0. Uri.vewTyr� shal ] hP comnletPlv ctired h�Yore �3rivine on t.hem. <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � ��� The undersigneA owneUapplicaN hereby a9rees lo hold'nnd sa�e harm- <br /> � � less the City of Everett fmm any and all claims fo� damages. ��sts. <br /> expenses, or causes ol aclion ihal may arise uecause of ins�alla�ion <br /> r�� � 1 � �� I _ L- � _c�� and maintenance ot the improvemenl or other right-of-way use her=to <br /> l � applied lor and furiher a9rees to remove same upon notice ��om the <br /> �-/l � � Date C�ry and to replace public property damaged thereby. <br /> Approved lor Conslru lio�/ <br /> / <br /> �' Z -' /) .�s '�/,� 7 <br /> �-�<<__�_ �_ 1- ' ��fit�� />>--—�=`- <br /> Date Dat� <br /> FINAL INSPECTION SignaWre of Applicant <br /> ApProved as Conslructed pJORK AUTHORIZED BV THIS PERMIT MUS� BE ST RTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED �•ND THEREAFTER IS TO <br /> ��r��� 3200CedarSireet BE DILIGENTLY PURSUED TO COtdPLETION.THIS PERMIT MAV BE <br /> Everetl.WA 98z0� GANCELLED DY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PPOJ[CT OV[R 90 DAYS DURATION. <br />