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Applicetion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett,INA 38201 (425)257•8810 <br />Date 514l99 � <br />Public Works Pertnit N ' 1 ( � 3 <br />:l <br />Building Pertnit N C62348 <br />TYPE OR PRINT ONLY Tp POSTINf���� ��-�4 —�--'—' � �;�� ": Public Worlcs Fee S`�`'' ___ <br />��. '.�1 a�:�.i ,Y� i'1 I: .d. t> O O!1 C•U 1•. <br />.. �u :� i ., [� ,.. `-o c� i ..; r�� io c� u. ��,� <br />BLUE RIDGE CONSTRUCTION PO BOX 302 DUVALL 98019 206-819-7413 '" ' � <br />Owner Mt�iling F ddress <br />CONTACT: MICHAEL HIRATA <br />Describe Proposed Work <br />PRCV[CTADDRESS (if known) <br />Gity Zip Phtne . � <br />.- r-� ��.n �o �ii ir � .. a. <br />_� 'I r' _I: n' .� t��l J F- <br />I' '' i ' � �. i . -- .il s <br />citv .., i �. i -_ , . 1Zio . . . . _ :� �.�_ Phmo r ` <br />Attach faur (4) copies plens lor proposed work • Drew to scsle and rwte the fdlowing II applicable: <br />• Properry Unes • Outline and dimensfons ol all existing arW proposed stnictures on the bt • Ezisting end proposed utilitles <br />Centedine of street • IMMate NoM • Show any proposed grad��ng changes • Show measurembnts <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be peAortned in accordance with this permit and current City ot Everett Design and <br />Construction Standards and Specifications. , <br />3. Call Location Underground Service 48 hrs. before yrou dig. TOLL FREE NUMBER 1-800-42�-5555. <br />�, kcep cily sl�ccts clecui nf xll limcs. <br />•�. ('iuh giiticr +tnd :;idewalk iu thr. plat e�r<r ucw nud �nidncu�ged, iuiy de�u�nge: iherelo wliril) <br />Ue rc.�iliiccd att iL,: disercliuu ofihc Puhlic V�Jocks Inepector. <br />fi. All� C1ltltt�f itI (lIC (�1'IVCWil�' CIII ��nial bc .ipproved l,,v t.Le Public V✓orks iuspector, a�idiLi nt <br />pro�� liue lituitr�l tc� cxisting eprnu width <br />.. A(I�I1RL N;iler boxeti to grc� ic eif eud of coush»oCiou.. <br />R, Uiiucwiiys c+licill be completcly curcd beti�re diivuig on �1�:�, <br />4. Rooftop drrtinegc sLall be di;�chttrged to tkte lo�u �tnrni draiiu�gc 4tnh provi�leri xt the Gont <br />ol t.l�c� lot. C.lII �OI' Ill9}1C.CUOU }1[YOi YO COVCt]t1Q,. <br />I�i. tiidr. �cwcr zix pci �itY wit��«liud q(01. <br />� <br />as <br />'J <br />�.�r <br />Date <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDOEMENT OF CONDRIONS <br />the undersipnetl ownerlepplkaM Mreby nqrssa to I�old and save hamdess <br />Ihe Ciry of Everett irom eiry end all dalms la damapse, oosta, ezpeneen, or <br />causes w acaa, n,a� may ai+ea wcause a kapwena, ana ma�nbn.noe a aie <br />hnproveraent a olher �iphtol•wey uw Mreto eppNed br �nd IuMer aproes b <br />rertave same + hom lhe qN �eWs� P�� WoPshY dam- <br />aoed me� et <br />. � ;,.� s/z/9� <br />, ican <br />W'O�C<AUT}K7R�D BY THIS PERMR MUST BE STARfED NRIF'r.: �BO DAYS OF DATE PERMfi IS �SSUED AND 7FEi�Af'IEA IS lU � DIJOB�IILV PI�SUED TO <br />OOMPlETION. iHIS PERMfT M4Y BE CANCELLED BY TTf CRV U��ON ANY STOPPAQE OF ViA7Fi( ON 7HS PRQECT OVER 9D DAYS OUM710N <br />