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Date 9 13 91 � <br />APPIicBlion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� PuoIS Wer\�C��mll • <br />� eieo oeoi. • �%Z77IZ- <br />�,e,K wo�.... <br />,a.� ��, s <br />tr�uoa� ve�n�M f <br />en.�ce o�, f <br />Joanne Obear 602 Morgan C[ Everett 98203 348-5312 <br />Owner MaiiinpAAdress City Zip P�one <br />Threshold Genl Con[recror 4802 Harbor Ln Everett 98203 348-6947 <br />Applicenl MsilinBA40res5 Cily 2ip Phono <br />DescriEeProposadWork Add mnxrnr hatl+ n� � 8 f il�. 499CF <br />Projetl Atl��us5 pl Fnown) 602 Morgnn C[ <br />Al1acM1 lom �4) �opies ol plens lor proposetl w�rk � Draw to scale and nolo t�e IollowinB as applicable: <br />• Property Lines • Centedine ol sl�ee� <br />• Oullme antl dimensions ol all erisling antl • Indicale Norih <br />pronosed slruc�ures on me te� • Show any pmposetl gradinq chan9ec <br />• Eai51in8 antl proposetl ulilities • Show mea5urement5 <br />PEflM1T CONDITIONS <br />1. All Cells lor inspection shall be mede 24 hrs. in ativance- phone 259•8810. <br />2. All work shall be peAormetl in eccordance with Ihis pormit end wrrem City ol Everert Desiyn end Constmctlon <br />Slendartls ena Specifitaiions. <br />3. Call Location Undergrountl Service qB hrs. �elore you tlig TOLL FREE NUMBEp 1•800-424•5555. <br />P�,IJGe (f,a'e�u�Gi'. oi.! �:'� �ijf-[.xvrY� <br />L,' / <br />�.�h� <br />%i�-�/ <br />ApProvetl lOr Consimttion Dale <br />FINAL INSPECTION Dale <br />ApPmveO as Const�ucted <br />�PUBUCWORKSUEPAHTMENT <br />9200 CeOar Streel <br />Eveietl, Wq 9BP01 <br />Pbone:259�8810 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />ZI <br />O <br />The vndersigne0 owner/appl¢anl �ereby agrees to holtl and save harm� <br />less Ihe City ol Evnrett Iram any and all c�aims lor damages, costs <br />eepenses, or causes ol aclipn I�at may arise because ol inslaliation <br />entl maintenante ol I�e impmvement or other rig�pol�way uso bereto <br />applied lor anE lurt�er agrees to remove same upon nolice Irom t�e <br />Cily end lo �eplatC publit propetly dBmaqeA Ihere�y. <br />Signature ol Appl�cant Oate <br />WORK AUTHORIZED BV Tf/15 PERMIT MUST BE START[0 WITHIN <br />I�0 DFVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSU[0 TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE C17V UPON ANV STOPPAGE OF WpFK ON THIS <br />PROJECT OVEfl 90 DAVS DURATION. <br />