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L-3(� -Z9-�i- <br />Date_8�5-92 <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only TO POSTING__��L^ �; <br />r�euc'xo���ce�mn. �� � � <br />nie� o.o� • 37715 <br />v�euc wm.� r.e <br />temr�, S <br />leu �oo� r.. v�b S <br />e.�..<.o.s f ZO <br />Michael llealow 16910 3rd Ave SE Bothell WA 98012 743-3526��� -�� <br />Owner MadingA�tlress Cily 2ip � Pnone <br />Owner <br />Applitanl Mailing AUdre55 Cily Zip PnonE <br />Oescribe Propased Work <br />PrDICci Atltlress U� Fnown) <br />Attach iw� 141 cop�es of plans lm p�oposetl work � Draw to scale and ncle Ihe lollowlnfl as apphcable: <br />• P�oOerty Lines • CeNcdine ol slreet <br />• Outline and dlmensions ol all caisting antl • Indicete Norih <br />pmposed sVucWrr.s on Ihe lot •$ho�.v any pioposetl gra0inp c�angos <br />• Ensting and propased uliltlies • Shnw measuremenls <br />PEFAl1T CONDITIONS <br />1. All calls lor inspection s�ell be ma0e 24 �rs. In ativance � p�ono 259•8810. <br />2. All work shall be per7ormed In actartlance with ��is permil antl urront City ol Everett Design enC Construclion <br />Slantlards antl Specifications. <br />3. Call Locntlon Undergmund Servite 48 hrs. belore you dig. TOLL FREE NUMBER 1•8�0-424•5555. <br />y 8_ <br />Da�e <br />as <br />�PUBLIC\VORKSDEPARTMENT <br />� 3200 CeOar Slmet <br />Everelt. WA 98201 <br />P�onc 259�8810 <br />ACkNOWLEOGEMENT OF CONDITIONS <br />Z <br />O <br />H <br />� <br />O <br />a <br />T�e un0ers�gnrd owneNap0licanl heieby agrees to hold and save haim� <br />Inss ihe Gry ot Eve�etl Imm any and all claims lor tlamages, costs. <br />utpen s. or causes ol . ction Ihat may arise �ecause of inslallation <br />a m i lendnce of Ine imp�ovemenl ar ather �igh4o4wey usc nereto <br />a I, � 1 r anG lutlher a9ree5 to �emove seme upon nati<e Imm ihe <br />Gt d �eplace public pmperly damagetl there0y. <br />y ` �v <br />S�gna W re ol Apphcant �al <br />WORN AUTHORIZED BY THIS PEFMIT MUSi BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUE� TO COMPLETIOti. TNIS PERMIT MAY BE <br />C.INCELLED BV iME CIiV UPON ANY STOPPAGE OF WORK ON TMIS <br />PPOJEGT OVEfl �JO CrVS DURATION. <br />