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��� <br />o�x <br />C, M <br />9HN <br />r <br />y H <br />�H� <br />� M'i1 <br />CA H <br />�o� <br />OHd <br />��g <br />�Y (C] <br />�HITJ <br />HH <br />8 �' <br />C] C❑ V� <br />L■1 <br />H� <br />H O p� <br />Date 4—Z�^91 <br />qpplication For <br />PUBLIC W�RKS PERMIT <br />Print or Type Only <br />/� <br />ppplicanl <br />Mailinp <br />/I <br />� 70 <br />9 <br />PuCI¢ Worha Permit a <br />eiae- Deo�- • <br />PUCLc Workf Poe g <br />TolalFna <br />Lese RpO� Fee PaiC 5 � m� <br />� .�i <br />Oalanro Duo <br />�3z� N�s�v s? i=��,�����' <br />Ciry Zip <br />,, <br />�i <br />/ <br />e u�r c t��? ��tf�o,�in�,��G Y 5' 6 <br />Descri6e Proposed Work <br />project Aodress 1�1 known) <br />Attach lour (4) copies ol plans for proposed work - Draw to scnle and note. Cenlfedine ol streeii able: <br />• Properry Lines • Indicale North <br />• Outline and dimensions of all eaisling and � Show any proposetl grading changes <br />proposed structures on the lot � Show measurements <br />• Existing and proposed utilities <br />p�?o / o <br />Phone <br />„ <br />Phone <br />lL" <br />PERMIT CONDI710NS <br />1. All calls for inspeclion shall be made 24 hrs. In advance • phone 259-88i O. <br />2. All work shall 6e pedormetl in accordance wilh �his permit and current City ol Everelt Design and Constmclion <br />StendarGs and Specifications. <br />3. Call Location Underground Service 48 hrs.6efore you dig. TOLL FREE NUMBER 1-500•424•55 . <br />F'r1�'c /��< <�'`�.sro��c ; �anl <br />q - cac� ve�uv,s <br />����� ��, <br />�' �3 9 - 7��3 <br />- 7Y� �Zy'9/ <br />qpprove for Conslru liQn <br />Dale <br />_,-.�a`� ��,���/. T" y j�-�l/ <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�Ar�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />�4/29/91 <br />/ <br />N00049648 <br />GF1'.20 <br />L41SH <br />-3�'69 <br />i:soF�t aooaus^i? <br />4,20.00 <br />g?0,00 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />Z <br />O <br />� <br />O <br />a <br />The undersi9ned owner/applicant hereby agrees to hold and save harm� <br />less Ihe Ciry of Everell Irom any and all claims lor damages, costs. <br />expenses, or causes of action thal may arise because of insiallation <br />and maintenance ol Ihe improvemenl or other righbot�way use hereto <br />applied for and luriher agrees to remove same upon notice irom the <br />City and to replace public property damaged Ihereby. <br />' ��. 7��.�'/�/IQ�/� ��3 9� <br />Date <br />Sig Wre of Applicant <br />1NBORDAYSTOFRDATE� PERMIT ISEISSUED ANDBTHEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />